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• Re: Macedo A Jr, Rondon A, Bacelar H, Leslie B, Ottoni S, Liguori R et al. An alternative channel for the Mitrofanoff principle based on transverse skin flaps: An extraperitoneal minimal invasive approach (the RPM technique). J Pediatr Urol 2012 Mar 23 [Epub ahead of print].

  Authors: Rahul Yadav, Neeraj K Goyal, Apul Goel

  Journal of pediatric urology.

• Quantified outcome for patients with bladder exstrophy.

  Authors: Ravi Prakash Kanojia, Sumit Agarwal, Kirti K J Rathod, Monika Bawa, Prema Menon, Jai K Mahajan, Ram Samujh, K L N Rao

  Journal of pediatric urology.

  AIM: Outcomes of bladder exstrophy patients were studied in numerical terms using scoring systems for continence and health-related quality of life (HRQOL), along with renal function, in short-termAIM: Outcomes of bladder exstrophy patients were studied in numerical terms using scoring systems for continence and health-related quality of life (HRQOL), along with renal function, in short-term follow up. PATIENTS AND METHODS: Patients who had undergone bladder-preserving exstrophy repairs, either staged or as a single procedure, and those who had been managed by bowel augmentation were included. Continence was assessed according to five variables (max. score 15) and HRQOL assessment was by means of a structured modified questionnaire scored on a Likert-scale model (max. score 150). RESULTS: A total of 39 patients were followed. Mean age was 8.3 years and mean follow up duration 3 years. Mean HRQOL score was 107.55 (83-133, SD ± 19.31). Mean continence score was 8.73 (6-11, SD ± 1.544). CONCLUSIONS: Evaluation of bladder exstrophy outcomes should not be done merely by reporting the length of dry intervals. If performed in numerical terms as outlined in this series, patients across centres will be comparable over a common assessment protocol. Continence score achieved in this series was low in comparison to the literature due to the strict evaluation protocol.

• High prevalence of intratesticular varicocele in a post-orchidopexy cohort.

  Authors: Annebeth Meij-de Vries, Femke M den Bakker, Floor S W van der Wolf-de Lijster, Rob W Meijer, Joery Goede, Hugo A Heij

  Journal of pediatric urology.

  PURPOSE: Intratesticular varicocele (ITV) is an uncommon sonographic finding. A prevalence of up to 2% has been reported in men with testicular problems. In a cohort of men who had undergonePURPOSE: Intratesticular varicocele (ITV) is an uncommon sonographic finding. A prevalence of up to 2% has been reported in men with testicular problems. In a cohort of men who had undergone prepubertal orchidopexy for acquired undescended testis, several cases of ITV were found. The aim of this study was to analyse the prevalence and clinical aspects of ITV in this cohort. METHODS: In a long-term follow-up study of position and growth of undescended testis after prepubertal orchidopexy, ultrasonography was used to identify men with ITV. Data on clinical presentation, testicular volume, and the location, size and Doppler aspects of intratesticular varicocele were collected and analysed. RESULTS: Of the 105 men, 9 were identified with ITV (8.6%). In all patients, the side of orchidopexy correlated with the side of the ITV, and all were left-sided. The testis with ITV had a smaller volume than the testis without ITV (p = 0.026). CONCLUSIONS: A remarkably high prevalence of ITV (8.6%) was found as well as a smaller volume of the testes with ITV in a cohort of men who had undergone prepubertal orchidopexy for acquired undescended testis.

• Granulocytic sarcoma of the urinary bladder in a pediatric patient.

  Authors: Julio Kaplan, Esteban Dardanelli, Sergio Sierre, Silvia Moguillansky, José Lipsich

  Journal of pediatric urology.

  Granulocytic sarcoma (GS) is a rare tumor consisting of immature cells of granulocytic lineage. It is also called chloroma, referring to the green color of the tumor caused by high levels ofGranulocytic sarcoma (GS) is a rare tumor consisting of immature cells of granulocytic lineage. It is also called chloroma, referring to the green color of the tumor caused by high levels of myeloperoxidase in the cells. GS is often associated with acute myeloblastic leukemia. We report the case of a 4-year-old boy with a diagnosis of acute myeloblastic leukemia. Abdominal ultrasonography demonstrated a solid, vascularized, heterogeneous, polypoid formation involving the posterior wall of the bladder. Further studies confirmed the etiology of the tumor. On control ultrasonography, a marked decrease in tumor size 15 days after treatment was revealed. We describe the imaging findings in this patient and review the literature about this infrequent entity. Although imaging findings are not specific and considering that extramedullary involvement in leukemia is very sensitive to treatment, inclusion of GS in the differential diagnosis and awareness of the possible sites of occurrence and imaging features is essential to avoid unnecessary therapeutic measures.

• Penoscrotal edema and purpura in a 12-year-old boy: A case report and review of causes.

  Authors: Anne G Dudley, Janelle A Fox, Miguel Reyes-Múgica, Glenn Cannon

  Journal of pediatric urology.

  We report the case of a 12-year-old patient with previously diagnosed Crohn disease who presented with penile edema and purpura, with extension into the scrotum. Subsequent work-up including biopsyWe report the case of a 12-year-old patient with previously diagnosed Crohn disease who presented with penile edema and purpura, with extension into the scrotum. Subsequent work-up including biopsy led to the diagnosis of extraintestinal Crohn disease, a rare manifestation in the genital region. Prompt treatment with steroids led to complete resolution of both penoscrotal edema and purpura. We describe our case, followed by a discussion of etiologies of penoscrotal edema and purpura as a review for the practicing pediatric urologist.

• Ureteric extension of Wilms' tumour: A case report.

  Authors: Giampiero Soccorso, Chitra Sehuraman, Mudher Al-Adnani, Daniel Yeomanson, Jenny Walker

  Journal of pediatric urology.

• Granulomatous orchitis in a pre-pubertal school-aged child: Differential diagnosis dilemmas.

  Authors: Lisieux E Jesus, Kátia L M Rocha, Maria L R Caldas, Elissa Fonseca

  Journal of pediatric urology.

  A 6-year-old male presented with testicular growth and persistent chronic orchiepididymitis with high inflammatory markers (C reactive protein and erythrocyte sedimentation rate). Biopsies of theA 6-year-old male presented with testicular growth and persistent chronic orchiepididymitis with high inflammatory markers (C reactive protein and erythrocyte sedimentation rate). Biopsies of the testes and epididymides showed bilateral epididymal and testicular granulomata, testicular fibrosis and chronic inflammatory infiltration, and the histological diagnosis was granulomatous orchitis. The symptoms receded with oral corticosteroids. Although rare, granulomatous orchitis is a possible diagnosis in children presenting testicular enlargement. It is important to differentiate it from testicular tumors (if necessary with testicular biopsy) and to investigate its association with systemic vasculitis and infectious diseases.

• Dextranomer/hyaluronic acid bladder neck injection for persistent outlet incompetency after sling procedures in children with neurogenic urinary incontinence.

  Authors: Daniel Dajusta, Patricio Gargollo, Warren Snodgrass

  Journal of pediatric urology.

  PURPOSE: We report outcomes after dextranomer/hyaluronic acid (Dx/HA) bladder neck injection for persistent outlet incompetency despite prior sling or Leadbetter/Mitchell bladder neck revision plusPURPOSE: We report outcomes after dextranomer/hyaluronic acid (Dx/HA) bladder neck injection for persistent outlet incompetency despite prior sling or Leadbetter/Mitchell bladder neck revision plus sling (LMS) in children with neurogenic urinary incontinence. METHODS: Consecutive patients with outlet incompetency after sling (n = 17) or LMS (n = 9) underwent a maximum of 2 Dx/HA injections. Antegrade and/or retrograde endoscopy was used to access the bladder outlet, and injection done in quadrants to achieve visual mucosal coaptation. Outcomes were described as either "dry", not requiring pads, or "wet". RESULTS: There were 24 children with follow-up after injection, of which 9 (38%) were initially dry and 15 (62%) remained wet. Of the 9 dry patients, 4 had recurrent incontinence at a mean of 16 months while 5 remained dry at a mean of 27 months. Second injections were done in a total of 14 children, with 1 dry at 39 months. Of all 24 children, up to 2 injections resulted in 6 (25%) dry patients, while the remainder was wet at last follow-up. Gender, initial outlet surgery, pre-injection pad use, injection technique, and volume injected did not predict outcomes. CONCLUSIONS: Dx/HA bladder neck injection resulted in dryness in 25% of patients in this series after failed sling or LMS. Second injections after either initial failure or success achieved dryness in only 7%, and are no longer recommended.

• Methylphenidate-induced erections in a prepubertal child.

  Authors: B D Kelly, D J Lundon, D McGuinness, C M Brady

  Journal of pediatric urology.

  Methylphenidate is a medication used routinely in the management of attention deficit hyperactivity disorder. We report a case of a prepubertal child who developed unwanted erections after commencingMethylphenidate is a medication used routinely in the management of attention deficit hyperactivity disorder. We report a case of a prepubertal child who developed unwanted erections after commencing a response-adjusted dosing regimen of sustained release methylphenidate. Despite priapism being a rare adverse reaction associated with methylphenidate, physicians and parents need to be aware as it can have significant long-term complications.

• A neosphincter for continent urinary catheterizable channels made from rectus abdominal muscle (Yachia principle): Preliminary clinical experience in children.

  Authors: Antonio Macedo, Eulálio Damázio, Herick Bacelar, Atila Rondon, Sérgio Ottoni, Riberto Liguori, Gilmar Garrone, Bruno Leslie, Valdemar Ortiz

  Journal of pediatric urology.

  PURPOSE: We investigated continence outcomes for patients undergoing primary or redo reconstruction of a urinary catheterizable reservoir involving the Yachia technique of intersecting two rectusPURPOSE: We investigated continence outcomes for patients undergoing primary or redo reconstruction of a urinary catheterizable reservoir involving the Yachia technique of intersecting two rectus abdominis strips over the outlet channel. MATERIALS AND METHODS: A retrospective evaluation of 22 consecutive patients operated from March 2009 to August 2010 was performed, consisting of 16 primary reconstructions (Macedo catheterizable ileal reservoirs) and 6 rescue cases for leaking stomas. Our data comprised 18 spina bifida patients, 1 sacral agenesis, 1 posterior urethral valves and 1 genitourinary tuberculosis. Mean age at surgery was 8.5 years (3-21 years). We evaluated continence at 3, 6, 12 months, and at the last follow-up based on data from urinary charts. RESULTS: Mean follow-up was 21.1 months (12-29 months). Overall continence was 100% for the primary cases and 66% for the redos (2/6 failed). Three patients had initial difficulty in performing clean intermittent catheterization but this resolved with time and experience. CONCLUSION: Using Yachia's technique has improved the continence rate of our catheterizable reservoirs and was partially successful for suprafascial revision of incontinent conduits.

• Age does not impact risk for urethroplasty complications after tubularized incised plate repair of hypospadias in prepubertal boys.

  Authors: Nicol Corbin Bush, Michael Holzer, Song Zhang, Warren Snodgrass

  Journal of pediatric urology.

  OBJECTIVE: Patients often present before or after the recommended age of 6-18 months for hypospadias repair. Reports indicate complications may increase when repair is delayed past 6-12 months ofOBJECTIVE: Patients often present before or after the recommended age of 6-18 months for hypospadias repair. Reports indicate complications may increase when repair is delayed past 6-12 months of age. We questioned if age was an independent risk for urethroplasty complications (UC). METHODS: A prospectively maintained database of consecutive patients undergoing tubularized incised plate (TIP) repair was queried for age at surgery, primary or reoperative TIP, meatal location, glansplasty suture, and learning curve. The presence of UC (fistula, dehiscence, stricture, meatal stenosis) was analyzed with logistic regression. RESULTS: TIP repairs were performed for 669 consecutive prepubertal patients aged 3-144 months (mean 17.1, SD 22.5). Original meatal location was distal in 540 (80.7%), midshaft in 50 (7.5%), and proximal in 79 (11.8%). Reoperative TIP occurred in 73 (10.9%). UC occurred in 77 (11.5%). Reoperative TIP (OR 3.07, 95% CI 1.54-6.13) and meatal location (OR 1.79, 95% CI 1.34-2.40) were the only independent risk factors for UC. Neither younger nor older age increased risk for UC. CONCLUSIONS: Our data from consecutive TIP repairs in prepubertal children indicate age at surgery does not increase odds of UC. Surgery can be performed any time after 3 months (in full-term, healthy boys) without raising the rate of UC.

• Pediatric urology fellowship training: Are we teaching what they need to learn?

  Authors: Ming-Hsien Wang, Belinda Chen, David Kern, Susan Gearhart

  Journal of pediatric urology.

  OBJECTIVE: Pediatric urology training has traditionally been based on an apprenticeship model. As part of our curriculum re-development, we surveyed recent graduates (2007-2009) regarding theOBJECTIVE: Pediatric urology training has traditionally been based on an apprenticeship model. As part of our curriculum re-development, we surveyed recent graduates (2007-2009) regarding the teaching of clinical/surgical skills and medical knowledge during their training. METHODS: 44 pediatric urologists who completed 2 years of ACGME (Accreditation Council for Graduate Medical Education)-accredited programs and had been practicing for at least 18 months were anonymously surveyed. An IRB-approved survey was developed by a team of educators at the Johns Hopkins School of Medicine and Bloomberg School of Public Health. RESULTS: 31 of 44 responded to 100% of the questions; 90% of the respondents felt their fellowship successfully prepared them for discussing surgical options and performing the procedures that they are now doing; 74% felt well trained to manage perioperative complications and 65% felt well trained to manage non-surgical problems. Faculty feedback/supervision, independent reading, and conferences were rated as a very effective method of teaching (87%). Top three procedures they wished they had learned: laparoscopic/robotic surgery, hypospadias repair, and augmentation/Mitrofanoff. Top three non-surgical topics: urinary tract infection, voiding dysfunction, and billing/coding. CONCLUSION: It is reassuring that ACGME fellowship-trained pediatric urologists feel prepared in commonly performed procedures and perioperative care. Faculty supervision/feedback is highly valued.

• Commentary to "Wang MH, Chen B, Kern D, Gearhart S. Pediatric urology fellowship training: are we teaching what they need to learn? J Pediatr Urol (2012)"

  Authors: Caleb P Nelson

  Journal of pediatric urology.

• Adults with myelomeningocele: An interview study about life situation and bladder and bowel management.

  Authors: Magdalena Vu Minh Arnell, Katarina Seljee Svedberg, Birgitta Lindehall, Ulf Jodal, Kate Abrahamsson

  Journal of pediatric urology.

  AIM: To assess life situation, and bladder and bowel management in individuals with myelomeningocele (MMC) after transferal to adult medical care. MATERIALS AND METHODS: All individuals (134) withAIM: To assess life situation, and bladder and bowel management in individuals with myelomeningocele (MMC) after transferal to adult medical care. MATERIALS AND METHODS: All individuals (134) with myelomeningocele from western Sweden, born before 1981, and assessed on at least two occasions by a pediatric urologist, were invited to participate in a telephone interview according to a structured protocol. Sixty-nine individuals (32 males, 37 females) with a median age of 34 years (range 27-50) agreed to participate. RESULTS: Sixty-two individuals (90%) passed high school or had university education and 46 (67%) were employed. Fifty-three (77%) had their own apartment and 27 (39%) lived with a partner. Clean intermittent catheterization was used by 49 (71%), more commonly in females (p < 0.05). Pads were used by 60 (87%) individuals. Ten (14%) had urotherapy support. Of those operated on, 16 (53%) had a consultation with a urologist every 3 years; the corresponding number for the non-operated was 12 (31%). Eight individuals were treated with anticholinergic drugs. None had support for improvement of the fecal emptying regimen. CONCLUSIONS: Of the participants in the study, one third had no or rare contact with a urologist, few had urotherapy support and none had support for bowel regimen.

• Isolated penile lymphedema in an adolescent male: A case of metastatic Crohn's disease.

  Authors: D D Sackett, J S Meshekow, T E Figueroa, J A Napoli

  Journal of pediatric urology.

  OBJECTIVE: Metastatic Crohn's disease is a rare and complex inflammatory condition distinguished by cutaneous granulomatous lesions outside the gastrointestinal tract. Genital involvement is rare;OBJECTIVE: Metastatic Crohn's disease is a rare and complex inflammatory condition distinguished by cutaneous granulomatous lesions outside the gastrointestinal tract. Genital involvement is rare; with less than 10 cases reported involving isolated penile lymphedema. Here, we present a case of isolated lymphedema of the penis as a consequence of extra-intestinal Crohn's disease. CASE REPORT: The patient is an 18-year-old African American male with a complex history of inflammatory bowel disease, who initially presented with a chief complaint of 6 weeks of swelling of his penis at age 13. A modified circumcision and lymphangectomy of the penis were performed; histopatholgy demonstrated a granulomatous infiltrate and interstitial edema of the distal penis. CONCLUSION: Surgical intervention is an applicable therapeutic alternative and last-line therapy for treatment of isolated penile lymphedema in select patients with appropriate pathology, and can be a suitable adjunct to medical management in these cases.

• Differentiation of inflammatory from non-inflammatory causes of acute scrotum using relatively simple laboratory tests: Prospective study.

  Authors: Jakov Meštrović, Mihovil Biočić, Zenon Pogorelić, Dubravko Furlan, Nikica Družijanić, Davor Todorić, Vesna Capkun

  Journal of pediatric urology.

  OBJECTIVE: The differential diagnosis of an acute scrotum is of great importance in clinical practice and may be difficult in some cases. The aim of this study was to differentiate inflammatory fromOBJECTIVE: The differential diagnosis of an acute scrotum is of great importance in clinical practice and may be difficult in some cases. The aim of this study was to differentiate inflammatory from non-inflammatory causes of acute scrotum using relatively simple laboratory tests which can be performed quickly and easily outside a hospital setting. PATIENTS AND METHODS: From 2007 to 2010, 85 boys with acute scrotum were included in this prospective study. There were 28 boys with inflammatory and 57 with non-inflammatory causes. We investigated the role of erythrocyte sedimentation rate, C-reactive protein, leukocyte, white blood cell differential count, alkaline phosphatase, creatine kinase and child's age in differential diagnosis of the acute scrotum, differentiating inflammatory from non-inflammatory causes of the disease. We used receiver operating characteristics (ROC) analysis and logistic regression analysis. RESULTS: Statistically significant parameters in accurate differentiation between inflammatory and non-inflammatory causes of the acute scrotum were C-reactive protein (p = 0.001) and child's age (p < 0.001). These two parameters yielded the probability of an inflammatory outcome in the etiology of acute scrotum with sensitivity of 75% and specificity of 69.1%. CONCLUSION: C-reactive protein and child's age are helpful in differentiating inflammatory from non-inflammatory causes of the acute scrotum.

• Hydronephrosis in pediatric kidney transplant: Clinical relevance to graft outcome.

  Authors: Lei Chu, Bruce L Jacobs, Zeyad Schwen, Francis X Schneck

  Journal of pediatric urology.

  OBJECTIVE: To evaluate our pediatric renal transplant patient population at the Children's Hospital of Pittsburgh to better understand the clinical significance of hydronephrosis. MATERIALS ANDOBJECTIVE: To evaluate our pediatric renal transplant patient population at the Children's Hospital of Pittsburgh to better understand the clinical significance of hydronephrosis. MATERIALS AND METHODS: We retrospectively reviewed records of patients who had received a renal transplant in 1998-2008. Exclusion criteria included multi-organ transplants and allograft failure within 3-months. We determined the incidence of hydronephrosis and compared serum creatinine, incidence of pyelonephritis, rejection and vesicoureteral reflux between the hydronephrotic and non-hydronephrotic cohorts. Data were analyzed using descriptive statistics, Student's t-test and Pearson Chi-Square test. RESULTS: 51 patients (35 male, 68.6%) were identified. The mean age at time of transplant was 8.7 ± 5.9 years and the mean follow-up period was 45.2 ± 45.4 months. Common causes of renal failure included posterior urethral valves, renal dysplasia, reflux and prune belly syndrome. Twenty-five (49%) patients developed hydronephrosis. This was associated with worsening renal function (p = 0.008). Hydronephrosis was also associated with pyelonephritis (p = 0.03) and male gender (p = 0.004). Age at transplant may be a predictor of pyelonephritis: median age of 10 patients with pyelonephritis was 4.6 years (range 0.6-19.9 years). Hydronephrotic cohort had increased rate of reflux and rejection; as not all patients underwent voiding cystourethrogram and/or allograft biopsy, this result was not significant. CONCLUSIONS: Pediatric renal graft hydronephrosis was correlated with worsening renal function and increased incidence of pyelonephritis. More aggressive preoperative and postoperative urological testing and management should help preserve renal function.

• Commentary to 'Long-Term Incidence of Urinary Tract Infection after Ureteral Reimplantation for Primary Vesicoureteral Reflux'

  Authors: Antoine Khoury

  Journal of pediatric urology.

• Laparoscopic management of pediatric renal and ureteric stones.

  Authors: Vikesh Agrawal, Jitin Bajaj, H Acharya, R Chanchalani, V K Raina, D Sharma

  Journal of pediatric urology.

  OBJECTIVE: To assess the feasibility of laparoscopy in the treatment of pediatric urolithiasis, we report our experience with the transperitoneal laparoscopic removal of stones. METHOD: Renal pelvicOBJECTIVE: To assess the feasibility of laparoscopy in the treatment of pediatric urolithiasis, we report our experience with the transperitoneal laparoscopic removal of stones. METHOD: Renal pelvic stones of size ≥1 cm on ultrasound were included for laparoscopic pyelolithotomy while smaller stones were managed with shock-wave lithotripsy monotherapy. Intrarenal stones, calyceal stones, complete staghorn stones, multiple stones and kidneys with intrarenal pelvis were excluded. Ureteric stones included for laparoscopic ureterolithotomy were of size ≥1 cm in the upper, mid or lower ureter, and smaller stones not responding to non-operative treatment. RESULTS: A total of 22 procedures were performed: 12 pyelolithotomies, and 8 lower and 2 upper ureterolithotomies. Complete removal of calculi was accomplished in 21 (95.45%) procedures. Complications associated with laparoscopic lithotomy included urinoma (4.54%), failure (4.54%) and omental prolapse (4.54%). CONCLUSION: Laparoscopic lithotomy is safe and feasible in pediatric urolithiasis with pyelic and ureteric stones, with minimal complications and failure rate.

• Comparison of pneumatic and laser lithotripsy in the treatment of pediatric ureteral stones.

  Authors: Murat Atar, Mehmet Nuri Bodakci, Ahmet Ali Sancaktutar, Necmettin Penbegul, Haluk Soylemez, Yasar Bozkurt, Namik Kemal Hatipoglu, Suleyman Cakmakci

  Journal of pediatric urology.

  OBJECTIVE: To compare the effectiveness and safety of pneumatic and holmium:YAG laser lithotripters in the treatment of pediatric ureterolithiasis. PATIENTS AND METHODS: Medical records of patientsOBJECTIVE: To compare the effectiveness and safety of pneumatic and holmium:YAG laser lithotripters in the treatment of pediatric ureterolithiasis. PATIENTS AND METHODS: Medical records of patients treated using pneumatic (PL) (n = 29) or laser (LL) (n = 35) lithotripter between 2009 and 2011 were retrospectively analysed. The patients were evaluated with respect to age, gender, stone size, complications, and stone-free rates 1 month after the operation. RESULTS: For the PL and LL groups, mean ages (8.8 ± 3.4 and 8.3 ± 3.5 years), male/female ratios (19:10 and 22:13) and stone locations were similar (p > 0.05). Mean stone sizes were 55.6 mm(2) and 47.6 mm(2) in the PL and LL group, respectively, with no statistically significant difference (p = 0.850). Mean operative times were 20.5 min in the PL group and 25.2 min in the LL group, with a statistically significant difference (p = 0.020). Stone-free rates 1 month after intervention were 79% in the PL group and 97% in the LL group (p = 0.022). Stone migration was detected in the PL group (n = 6) and in the LL group (n = 1). No major complication was found in either group. CONCLUSION: In the ureteroscopic treatment of pediatric ureterolithiasis, both pneumatic and laser lithotripters are effective and successful. However, laser lithotripsy has a higher stone-free rate and lower complication rate.

• Commentary to 'Short-term outcome of mild isolated antenatal hydronephrosis conservatively managed'.

  Authors: Paul A Merguerian

  Journal of pediatric urology. 8(2):134.

• Bladder augmentation and urinary diversion in patients with neurogenic bladder: Surgical considerations.

  Authors: Raimund Stein, Annette Schröder, Joachim W Thüroff

  Journal of pediatric urology. 8(2):153-61.

  In patients with a neurogenic bladder, the primary goal is preservation of renal function and prevention of urinary tract infection, with urinary continence as the secondary goal. After failure ofIn patients with a neurogenic bladder, the primary goal is preservation of renal function and prevention of urinary tract infection, with urinary continence as the secondary goal. After failure of conservative treatment (clean intermittent catheterisation and pharmacotherapy) urinary diversion should be considered. In this review, the surgical options with their advantages and disadvantages are discussed. In patients with a hyper-reflexive, small-capacity and/or low-compliance bladder with normal upper urinary tract, bladder augmentation (bowel segments/ureter) is an option. To those who are unable to perform clean intermittent catheterisation via urethra, a continent cutaneous stoma can be offered. In patients with irreparable sphincter defects a continent cutaneous diversion is an option. For patients who are not suitable for a continent diversion (incompliant±chronic renal failure), a colonic conduit for incontinent diversion is preferred. Surgical complications specific to urinary diversion include: ureterointestinal stenosis, stomal stenosis, stone formation, bladder perforation, and shunt infection and obstruction. Surgical revision is required in around one third of patients. Careful lifelong follow-up of these patients is necessary, as some of these complications can occur late.

• Fetal urology.

  Authors: C D Anthony Herndon

  Journal of pediatric urology. 8(2):120.

• Editorial.

  Authors: J D Frank, P Mouriquand, A Caldamone, P S Malone

  Journal of pediatric urology. 8(2):119.

• Immunohistopathologic demonstration of deleterious effects on growing rat testes of radiofrequency waves emitted from conventional Wi-Fi devices.

  Authors: Halil I Atasoy, Mehmet Y Gunal, Pinar Atasoy, Serenay Elgun, Guler Bugdayci

  Journal of pediatric urology.

  OBJECTIVE: To investigate effects on rat testes of radiofrequency radiation emitted from indoor Wi-Fi Internet access devices using 802.11.g wireless standards. METHODS: Ten Wistar albino male ratsOBJECTIVE: To investigate effects on rat testes of radiofrequency radiation emitted from indoor Wi-Fi Internet access devices using 802.11.g wireless standards. METHODS: Ten Wistar albino male rats were divided into experimental and control groups, with five rats per group. Standard wireless gateways communicating at 2.437 GHz were used as radiofrequency wave sources. The experimental group was exposed to radiofrequency energy for 24 h a day for 20 weeks. The rats were sacrificed at the end of the study. Intracardiac blood was sampled for serum 8-hydroxy-2'-deoxyguanosine levels. Testes were removed and examined histologically and immunohistochemically. Testis tissues were analyzed for malondialdehyde levels and prooxidant-antioxidant enzyme activities. RESULTS: We observed significant increases in serum 8-hydroxy-2'-deoxyguanosine levels and 8-hydroxyguanosine staining in the testes of the experimental group indicating DNA damage due to exposure (p < 0.05). We also found decreased levels of catalase and glutathione peroxidase activity in the experimental group, which may have been due to radiofrequency effects on enzyme activity (p < 0.05). CONCLUSIONS: These findings raise questions about the safety of radiofrequency exposure from Wi-Fi Internet access devices for growing organisms of reproductive age, with a potential effect on both fertility and the integrity of germ cells.

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