hematoma in 0.1%. Testicular atrophy developed in 1 boy postoperatively, which necessitated subsequent surgery for undescended testis. In boys with no evidence of associated hernia the operation for hydrocele was postponed until age 1 year, which is similar to what we do in the United States. Of the entire group only 2.2% required urgent surgery because manual reduction was unsuccessful. Associated pathological conditions included umbilical hernia in 8% of patients, prematurity in 6%, hypospadias in 1.8% and heart defect in 1.7%. Contralateral hernia subsequently developed in 2% of patients, with fewer instances in females than in males. Douglas A. Canning, MD

Re: Age at Orchidopexy as an Indicator of the Quality of Regional Child Health Services C. J. Bruijnen, H. D. Vogels and S. W. Beasley Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand J Paediatr Child Health 2012; 48: 556e559.

Abstract available at Editorial Comment: The authors compare the age distribution of boys who underwent orchiopexy for undescended testis between 1997 and 2006 in the South Island of New Zealand and in the state of Victoria, Australia. If one presumes that the incidence of ascending testes is the same in each group, the authors propose that late referral and surgery for children with primarily undescended testes in Victoria resulted in a higher proportion of orchiopexies at ages 9 to 18 in Victoria compared to the South Island. Conversely lower rates of early diagnosis in Victoria resulted in a smaller proportion of boys undergoing orchiopexy between ages 0 and 4 years. The authors suggest that age at orchiopexy may be a surrogate indicator of the relative availability and quality of surgical care in a particular region. Douglas A. Canning, MD

Re: Ultrasound as a Screening Test for Genitourinary Anomalies in Children with UTI C. P. Nelson, E. K. Johnson, T. Logvinenko and J. S. Chow Department of Urology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts Pediatrics 2014; 133: e394ee403.

Abstract available at Editorial Comment: The recent American Academy of Pediatrics urinary tract infection (UTI) guideline recommends renal and bladder ultrasound (RBUS) instead of voiding cystourethrography (VCUG) after the first urinary tract infection. The authors show by analyzing a large institutional series of children with UTI in whom VCUG and RBUS were performed that RBUS is not a good screening test for vesicoureteral reflux. The accompanying editorial concurs but indicates that the screening tool is the second UTI, not the RBUS.1 The reasoning includes the observation that 90% of children will never have a second UTI, and, therefore, will be spared the discomfort, expense and radiation associated with VCUG. I believe that “the ship has sailed” regarding pulling back on the American Academy of Pediatrics recommendations. Our efforts should now be directed to ensure that every child with symptoms of

Re: Age at orchidopexy as an indicator of the quality of regional child health services.

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