Pediatric Urology

Management of the undescended testis in children: An American pediatric surgical association outcomes and evidence based practice committee systematic review.

Management of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable.

Evaluation of penile curvature in patients with hypospadias; gaps in the current practice and future perspectives.

Penile curvature (PC) is a significant phenotypic anomaly associated with hypospadias that can affect hypospadias repair post-operative outcomes and impact on long-term quality of life as well as psychosexual wellbeing of affected patients.

Update on pediatric testicular germ cell tumors.

Testicular germ cell tumors are uncommon tumors that are encountered by pediatric surgeons and urologists and require a knowledge of appropriate contemporary evaluation and surgical and medical management.

Efficacy of Topical Testosterone in Management of Scrotal Hypoplasia and Agenesis

Background Scrotal hypoplasia or agenesis may possess difficulty during orchidopexy or end with social anxiety around excessively small scrotal size when compared to peers, and where there may be concerns regarding the future sexual life.

Objective Any conservative modality applicable to ameliorate scrotal underdevelopment partially or completely will be useful either solely or before reconstructive surgery.

Study design Seventeen children (3–8 years) were diagnosed with bilateral scrotal hypoplasia (SH) in 5 unilateral in 7, bilateral scrotal agenesis (SA) diagnosed in 4 cases, and unilateral in one. Testicles are either undescended, ectopic, or normal. All cases managed by Testogel 1% topical testosterone for 4 weeks. Clinical assessment by measurements of the scrotal skin surface area (scrotal length multiplied by width) and scrotal corrugations counting. Inguinal and renal ultrasound done for all cases and karyotyping for cases of agenesis and cases with bilateral undescended testicles. Total and free testosterone, LH, FSH, and AMH hormones were assisted before treatment, weekly, and one week after therapy. Data analyzed and evaluated, difference of means used to test for statistically significant differences between scores of scrotal development.

Results Free and total testosterone elevated in the 1st week of treatment but restored to normal or higher levels in 60% of cases at the 2nd week. Satisfactory response (Increasing numbers of scrotal rugae or scrotal surface area by 30–50% above the pretreatment status) obtained in 85% and 60% of unilateral and bilateral SH, but only a partial response (10–20% increase) was gained in 40% of cases with agenesis. No major adverse effect was appreciated.

Discussion Response of some cases of SH to topical testosterone indicates presence of remnants of labioscrotal folds with testosterone receptors (Bell et al., 1971).1 Testosterone replacement therapy can improve the signs and well-being of a hypogonadal male by restoring serum testosterone concentrations to physiologic levels. In this study, the mean average testosterone concentration one week after application of testogel was 13.47 ± 2.45 and 12.12 ± 2.5 within 2nd, 4th week, and after cessation of treatment. Anti-Mullerian hormone is significantly low in 12 cases; mainly in cases of SA (P-value <0.001).

Conclusion Short-term topical testosterone proved to be effective in a considerable percentage of cases of either bilateral or unilateral scrotal hypoplasia; with a subsequent increase in scrotal surface area and number of rugae, it may substitutes the indication for surgical reconstruction. Long-term follow-up is a limitation of this study.
Authors: Omar Al Samahy, Doa Othman, Dalia Gad, M.A. Baky Fahmy, Pediatric Surgery, Al Azhar Faculty of Medicine for Girls, Egypt

Source: Omar Al Samahy, Doa Othman, Dalia Gad, M.A. Baky Fahmy, “Efficacy of topical testosterone in management of scrotal hypoplasia and agenesis,” Journal of Pediatric Urology, 2021, ISSN 1477-5131,

Is there a unique symptom in lower urinary tract dysfunction in children?

Lower urinary tract symptoms (LUTS), particularly urgency, incontinence and intermittency are common in children and it is suggested that the specific symptoms may be used for definite diagnosis for LUT dysfunction (LUTD).

Health Care-Associated Infections Among Critically Ill Children in the US, 2013-2018.

Central catheter-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) increase morbidity, mortality, and health care costs in pediatric patients.

To examine changes over time in CLABSI and CAUTI rates between 2013 and 2018 in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) using prospective surveillance data from community hospitals, children's hospitals, and pediatric units within general hospitals.

A prospective study of pediatric and adolescent renal cell carcinoma: A report from the Children's Oncology Group AREN0321 study.

To the authors' knowledge, AREN0321 is the first prospective clinical study of pediatric and adolescent renal cell carcinoma (RCC). Goals of the study included establishing epidemiological, treatment, and outcome data and confirming that patients with completely resected pediatric RCC, including lymph node-positive disease (N1), have a favorable prognosis without adjuvant therapy.

Pediatric and young adult renal cell carcinoma.

Renal cell carcinoma (RCC) is rare in children but is the most common renal tumor in adults. Pediatric RCC has different clinical characteristics, histopathology, and treatment compared with adult disease.

Comparison of miniaturized percutaneous nephrolithotomy and retrograde intrarenal surgery: Which is more effective for 10-20 mm renal stones in children?

To compare miniaturized percutaneous nephrolithotomy (mini-PNL) and retrograde intrarenal surgery (RIRS) in children with 10-20 mm renal stones. MATERIALS AND METHODS: Between 2015 and 2019, 63 pediatric patients aged under 16 years who under went mini-PNL and RIRS for the treatment of kidney stones sized 10-20 mm were analyzed retrospectively.

Cisplatin and carboplatin pharmacokinetics in a pediatric patient with hepatoblastoma receiving peritoneal dialysis.

Cisplatin and carboplatin are frequently used drugs in the treatment of pediatric hepatoblastoma. Dosing guidelines for these drugs in children requiring peritoneal dialysis are lacking. Here, we describe the case of a 3-year-old boy with pre-existing end-stage renal disease on peritoneal dialysis, requiring treatment with cisplatin and carboplatin for hepatoblastoma.

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