PEDIATRIC UROLOGY
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Editorial Comment: Is testicular microlithiasis a curiosity or a concern? Cambareri et al remind us that there are a few boys with microlithiasis in association with testicular tumor and suggest that the association is more than circumstantial. Goede and Hack look more carefully at the actual prevalence of testicular microlithiasis with a meta-analysis of 57 studies taken from a search of 472 articles that were included as potentially relevant to identify the prevalence of testicular microlithiasis and its relationship to benign and malignant entities. They conclude that the incidence of testicular microlithiasis in asymptomatic boys may be as high as 4.2%, whereas in symptomatic referrals it varies between 1.1% and 2.8%. They recommend regular self-examination from the age of 15 years and more regular followup by ultrasound in patients with testicular enlargement, Down syndrome or symptoms of testicular microlithiasis. Douglas A. Canning, MD
Re: Penile Duplication: Is it Necessary to Excise One of the Penises? M. Elsawy, J. L. Pippi Salle, M. Abdulsalam and A. N. Alsaid Ibn Sina Hospital, Safat, Kuwait J Pediatr Urol 2012; 8: 434e436.
Abstract available at http://jurology.com/ Editorial Comment: This is a new approach to the rare surgical problem of diphallia. These surgeons joined the nearly identical duplicated sets of corpora and covered them as a single entity with partial reduction of the glans on each side. The urethra from the dorsal penis was normal. The ventral urethra was hypoplastic. By joining the 2 penises, the authors avoided putting the boy through additional urethral and bladder neck reconstruction. The child now has a near normal penile appearance, with normal erections and a normal urinary stream. Thanks to the authors for adding this elegant tool to the reconstructive urology toolbox. Douglas A. Canning, MD
Re: Single- vs. Multi-Stage Repair of Proximal Hypospadias: The Dilemma Continues H. Badawy and A. Fahmy Department of Urology, University of Alexandria, Alexandria, Egypt Arab J Urol 2013; 11: 174e181.
Abstract available at http://jurology.com/ Editorial Comment: The authors reviewed MEDLINEÒ, PubMedÒ, Scopus and Ovid for publications during the last 10 years describing results following surgery in boys with proximal hypospadias. Not unexpectedly, the results are all over the board, with reports of as little as 8% to as great as 70% complication rates with single and multistaged repairs. Their conclusions, that the result depends on surgeon experience with the particular approach, make sense and underscore the importance of maintaining expertise in more than just a few techniques. As my career progresses, the cases I remember best are my failures, not my successes. These can be challenging, usually boys returning in late adolescence with residual curvature and a short penis. For me this has resulted in an evolution toward more staged and fewer single stage repairs, with an emphasis on achieving the longest, straightest penis possible. Douglas A. Canning, MD
1873
Editorial Comment: Is testicular microlithiasis a curiosity or a concern? Cambareri et al remind us that there are a few boys with microlithiasis in association with testicular tumor and suggest that the association is more than circumstantial. Goede and Hack look more carefully at the actual prevalence of testicular microlithiasis with a meta-analysis of 57 studies taken from a search of 472 articles that were included as potentially relevant to identify the prevalence of testicular microlithiasis and its relationship to benign and malignant entities. They conclude that the incidence of testicular microlithiasis in asymptomatic boys may be as high as 4.2%, whereas in symptomatic referrals it varies between 1.1% and 2.8%. They recommend regular self-examination from the age of 15 years and more regular followup by ultrasound in patients with testicular enlargement, Down syndrome or symptoms of testicular microlithiasis. Douglas A. Canning, MD
Re: Penile Duplication: Is it Necessary to Excise One of the Penises? M. Elsawy, J. L. Pippi Salle, M. Abdulsalam and A. N. Alsaid Ibn Sina Hospital, Safat, Kuwait J Pediatr Urol 2012; 8: 434e436.
Abstract available at http://jurology.com/ Editorial Comment: This is a new approach to the rare surgical problem of diphallia. These surgeons joined the nearly identical duplicated sets of corpora and covered them as a single entity with partial reduction of the glans on each side. The urethra from the dorsal penis was normal. The ventral urethra was hypoplastic. By joining the 2 penises, the authors avoided putting the boy through additional urethral and bladder neck reconstruction. The child now has a near normal penile appearance, with normal erections and a normal urinary stream. Thanks to the authors for adding this elegant tool to the reconstructive urology toolbox. Douglas A. Canning, MD
Re: Single- vs. Multi-Stage Repair of Proximal Hypospadias: The Dilemma Continues H. Badawy and A. Fahmy Department of Urology, University of Alexandria, Alexandria, Egypt Arab J Urol 2013; 11: 174e181.
Abstract available at http://jurology.com/ Editorial Comment: The authors reviewed MEDLINEÒ, PubMedÒ, Scopus and Ovid for publications during the last 10 years describing results following surgery in boys with proximal hypospadias. Not unexpectedly, the results are all over the board, with reports of as little as 8% to as great as 70% complication rates with single and multistaged repairs. Their conclusions, that the result depends on surgeon experience with the particular approach, make sense and underscore the importance of maintaining expertise in more than just a few techniques. As my career progresses, the cases I remember best are my failures, not my successes. These can be challenging, usually boys returning in late adolescence with residual curvature and a short penis. For me this has resulted in an evolution toward more staged and fewer single stage repairs, with an emphasis on achieving the longest, straightest penis possible. Douglas A. Canning, MD
