tubules diminished and contributed to by the well-known heat effect in

cryptorchid testis. The percentage of normal spermatogonia in biopsies

depends on the age at orchidopexy; therefore, the age for surgery has been

lowered over the years.

Reduced germ cell count and defective maturation is explained by

hypogonadotropic hypogonadism. Normally, follicle-stimulating hormone

mediates germ cell development and LH is required for full complement

of germ cells and final stages of spermatogenesis. These hormonal effects

are mediated via Sertoli cells. But even the Mullerian inhibiting substance

is involved in testicular differentiation. All of these effects are deficient in

cryptorchidism. Meta-analysis of studies on hormone treatment fail to

show convincing therapeutic success concerning descent of the cryptor-

chid testis. In addition to this questionable effect on the descent, the

routine use of human chorionic gonadotropin to stimulate testosterone

production shows some irreversible changes such as increased germ cell

apoptosis. Human chorionic gonadotropin use cannot further be justified.

Gonadotropin-releasing hormone (GnRH) stimulates pituitary LH and

follicle-stimulating hormone production, increase germ cell count, and

improved spermatogonia number. Even postoperative GnRH treatment

shows these effects.

The risk of testicular malignancy in cryptorchidism is estimated 4- to

8-fold, and carcinoma in situ has an incidence of 2% to 3%. It is still

inconclusive whether orchidopexy can prevent malignancy if it is done

before the maturation is defective, but the testis can be examined clinically

and with ultrasound.

Testicular germ cell maturation is a multistage process with 2 critical

postnatal steps. In cryptorchidism, heat effect, endocrine, and even

genetic factors result in defective maturation. Early age at orchidopexy

reduces germ cell loss, and adjunctive GnRH administration improves

maturation.—P. Schmittenbecher

doi:10.1016/j.jpedsurg.2005.10.040

Acute epididymitis in children: a 4-year retrospective studyHaecker F-M, Hauri-Hohl A, von Schweinitz D. Eur J Pediatr Surg 2005

(June);15:180 -186.

The aim of this study was to evaluate the incidence of acute epididymitis

(AE) in comparison with testicular torsion (TT) as a form of acute scrotum

in children and to describe clinical aspects and to assess the value of

laboratory tests and radiological investigations in AE. The medical records

of 49 patients presenting with clinical signs of AE were reviewed, including

evaluation of clinical features, laboratory tests (blood and urine),

radiological examinations (duplex and real-time ultrasound, renal sonog-

raphy, and voiding cystourethrography), and urodynamics. Forty-nine

patients with a mean age of 9.8 years (range, 0.2-15.3 years) were treated

for AE, whereas 31 patients required surgery for TT during the same period.

Local pain on palpation of the epididymis and/or testis were the most

common clinical signs. In 2 patients, urine cultures revealed significant

bacteriuria. Duplex and real-time ultrasound showed no false-negative

results. Forty-one percent of the patients revealed concomitant urological

diseases. Sixteen of the 21 older boys (76%) demonstrated normal uroflow

patterns. Acute epididymitis seems to be more common than acute TT.

Urinalysis and urine culture should be performed in all children with

AE. High-resolution ultrasound reliably excludes TT so that routine surgical

exploration is seldom necessary.—Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2005.10.041

Cutaneous vesicostomy revisited—the second 15 yearsVastyan AM, Pinter AB, Farkas A, et al. Eur J Pediatr Surg 2005

(June);15:170-174.

The aim of this paper is to review the authors’ experience with cutaneous

vesicostomy (CV) over the last 15 years, including indications, results,

and complications of CV. The records of 31 patients treated by CV

between 1987 and 2002 were reviewed (20 boys, 11 girls). The 2 main

primary pathologies were neuropathic bladder (19 patients) and posterior

urethral valves (7 patients). All patients underwent a Blocksom-type

operation at a mean age of 23 months (range, 14 days to 9 years). Pre-

and postoperative conventional uromanometry was performed in

18 patients (58%) and bladder function assessed. In 23 patients (74%),

CV provided a successful diversion with improvement of the upper

urinary tract and/or stabilization of renal function. In 5 patients (16%)

with posterior urethral valves, the improvement was temporary only. In

3 patients (10%), CV did not result in improvement. Twenty-four patients

underwent CV closure after a mean duration of 23 months (1 month to

7 years) of diversion. In 2 patients with myelomeningocele and severe

somatomental retardation, CV was not closed. Urodynamic studies in 5

patients with posterior urethral valves showed impaired compliance and

high intravesical pressure after a successful valve ablation and closure of

CV. In the neuropathic bladder group, bladder function improved after

closure of CV and commencement of anticholinergic medication and clean

intermittent catheterization. Augmentation rate in the neuropathic bladder

group was 22%. Complications after CV included 7 stenosis (22%), 2

prolapse (6%), and 2 cellulitis (6%). Revision rate was 16%. It was

concluded that CV had a less favorable outcome in young infants with

posterior urethral valves than in high-pressure neuropathic bladder with

upper tract dilatation and severe urinary tract infection, where CV

provided decompression and prevented deterioration of renal function.

Cutaneous vesicostomy has stood the test of time and remains a valuable

tool in selected pediatric urological patients.—Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2005.10.042

International Abstracts286