Chordee: varied opinions and treatments as documented in a survey of the American Academy of Pediatrics, Section of Urology.
Child; Data Collection; Humans; Male; Male/*methods; Medical; Pediatrics; Penis/*abnormalities/*surgery; Societies; Urologic Surgical Procedures; Urology
OBJECTIVES: Consensus has not been established as to the best treatment of congenital chordee. Outcomes analysis of treatment options are limited by the prevailing use of ambiguous terminology. We sought to clarify the frequently used term "significant chordee" and to measure the utilization of current treatment strategies. METHODS: A survey covering current practice patterns concerning congenital chordee with hypospadias was sent to 236 members of the American Academy of Pediatrics, Section of Urology. RESULTS: Correction of chordee was the primary concern in hypospadias surgery of 31 % of those responding, but it was not the primary goal of 54% of respondents. Findings indicate that "significant chordee" is clinically defined as curvature greater than 20 degrees, in that 75% of respondents said they would proceed with further intervention. Placement of plicating sutures was the most common therapy chosen for 20 degrees chordee, with 50% of respondents electing this approach. Consensus was reached at 30 degrees chordee, with greater than 99% intervening at this degree of curvature. At 30 degrees curvature, 48% used an incisional Nesbit procedure. As the degree of curvature increased, division or mobilization of the urethral plate became the most common intervention. With 50 degrees chordee, urethral plate manipulation was used 34% of the time. Sixty percent of the respondents believed the urethral plate did not often contribute to chordee. CONCLUSIONS: "Significant chordee" was believed to be a curvature greater than 20 degrees to 30 degrees. With 20 degrees, 30 degrees , and 40 degrees chordee, correction was most often approached dorsally. With 50 degrees chordee, 54% approached the problem ventrally. We hope to encourage the use of more objective measurements and terminology. Objective measurements and long-term follow-up will improve our understanding of the natural history of chordee and improve outcomes analysis.
Bologna R A; Noah T A; Nasrallah P F; McMahon D R
Urology
1999
1999-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0090-4295(98)00656-6" target="_blank" rel="noreferrer noopener">10.1016/s0090-4295(98)00656-6</a>
Male self health awareness
Pediatrics
Nasrallah P F; Nair G R; Bennett C; Congeni J; McMahon D R
Pediatrics
1999
1999-09
Journal Article
n/a
Management of grade IV renal injury in children
endoscopy; kidney; lacerations; nonpenetrating; trauma; Urology & Nephrology; wounds
Purpose: Conservative nonsurgical management of major renal trauma in children is well established. However, when blunt trauma is accompanied by significant urinary extravasation, options are less than clearly defined. Endoscopic techniques, such as stents and percutaneous drainage, have not been widely used because of small caliber. We present our experience with endoscopic management of grade IV renal trauma. Materials and Methods: From 1983 to 1996, 15 children satisfied the criteria for grade IV renal trauma. We retrospectively reviewed the charts to assess the mechanism of injury, associated injury, treatment, hospital stay and transfusion requirement. Patients were followed clinically with blood pressure and creatinine monitoring, and by radiograph with computerized tomography. Results: Nine patients with isolated kidney injury were successfully treated with observation, 1 underwent early partial nephrectomy for persistent anemia and hypotension, and 5 had a urinoma, which was successfully treated with percutaneous drainage only in 2. The other 3 patients underwent cystoscopy and ureteral stent placement for high drainage output, leading to the resolution of urine leakage. In 1 patient who underwent percutaneous drainage only renovascular hypertension developed, requiring partial nephrectomy 3 months after the original injury. The remaining 13 patients had complete radiographic resolution of the injury and no evidence of hypertension. Conclusions: In the pediatric population grade IV blunt renal trauma usually resolves without intervention. When a symptomatic urinoma develops, percutaneous drainage, accompanied at times by ureteral stenting provides the complete resolution of persistent urine leakage.
Russell R S; Gomelsky A; McMahon D R; Andrews D; Nasrallah P F
Journal of Urology
2001
2001-09
Journal Article
<a href="http://doi.org/10.1016/s0022-5347(05)65917-4" target="_blank" rel="noreferrer noopener">10.1016/s0022-5347(05)65917-4</a>
Role of positional instillation of contrast cystography in the algorithm for evaluating children with confirmed pyelonephritis
Urology & Nephrology
Objectives. To assess the utility of positional instillation of contrast (PIC) cystography in detecting vesicoureteral reflux (VUR) in patients with renal scarring from recurrent febrile urinary tract infections that standard voiding cystourethrography and nuclear cystogram imaging failed to reveal. Methods. Between June 2004 and November 2004, a total of 5 pediatric patients with recurrent febrile urinary tract infections and radiologic evidence of upper tract involvement were examined with PIC cystography. All patients had at least one previous negative standard reflux study (voiding cystourethrography or nuclear cystography). Results. All 5 patients showed VUR on PIC cystography. Unilateral reflux was detected in 3 patients, and 2 patients had bilateral VUR. Conclusions. The PIC cystogram should be integrated into the algorithm for diagnosing patients with recurrent febrile urinary tract infection, who do not exhibit VUR on standard imaging modalities. The morbidity associated with undiagnosed VUR, as demonstrated by this group of patients, suggests that permanent renal damage may be prevented by early diagnosis and treatment.
Tareen B U; Bui D; McMahon D R; Nasrallah P F
Urology
2006
2006-05
Journal Article
<a href="http://doi.org/10.1016/j.urology.2005.11.066" target="_blank" rel="noreferrer noopener">10.1016/j.urology.2005.11.066</a>
Testicular capillary hemangioma: an unusual diagnosis suggested by duplex color flow ultrasound findings.
*Ultrasonography; Adolescent; Capillary/*diagnostic imaging; Color; Doppler; Hemangioma; Humans; Male; Testicular Neoplasms/*diagnostic imaging
Stille J R; Nasrallah P F; McMahon D R
The Journal of urology
1997
1997-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00005392-199704000-00102" target="_blank" rel="noreferrer noopener">10.1097/00005392-199704000-00102</a>