International Abstracts896

Nuclear scintigraphy and Doppler ultrasound were used as diagnostic

tools in 116 boys. Clinical presentation parameters including a) previous

trauma, b) pain attacks, and c) nausea and vomiting had the highest

sensitivity, specificity, positive and negative predictive values in the TT

group and the lowest values in the EO group. In contrast, the EO group

had the highest values with regard to dysuria and micturition disorders.

Physical examination parameters consisting of a) elevation, b) transverse,

location of the testis, c) anterior rotation of epididymis, and d) absence of

cremasteric reflex had the highest values in the TT group. Imaging

studies had the highest specificity and positive Predictive values in the

TTA group and the lowest values in the TT group, Previous history of

trauma, pain attacks, nausea and vomiting and the absence of urinary

complaints were the main predictors of TT. Elevation and transverse

location of the testis with an anteriorly rotated epididymis associated with

loss of ipsilateral cremasteric reflex strongly indicate TT. Although accu-

racy of imaging studies is higher for the differential diagnosis of TTA and

EO, there is considerable risk of misdiagnosis. Therefore, differential,

diagnosis of acute scrotum remains a clinical diagnosis for surgical

decision making.—Thomas A. Angerpointner

Polyorchidism presenting with undescended testisAbbasoglu L, Salman FT, Gun F, et al. Eur J Pediatr Surg 2004(October);

14:355-357.

A case of polyorchidism is reported that presented as undescended testis.

Polyorchidism is defined as the presence of more than two testicles. As in

this case, most instances occur on the left side. The inferior testis is evidently

larger than the accessory testis in all cases described in the literature, and the

presented case is the first with the small testis located more distally than the

larger one. The accessory testis hack no reproductive capacity due to a lack

of attachment to a cord structure. It was therefore removed because of the

high risk of malignancy.—Thomas A. Angerpointner

Hormonal cryptorchidism therapy: systematic review with metanalysisof randomised clinical trialsHenna MR, Del Nero RGM, Sampaio CZS, et al. Pediatr Surg Int 2004

(May);20:357-359.

The proper treatment of cryptorchidism is still controversial. Success rates of

hormonal therapy with hCG vary from 0-55%, with GnRH from 9-78%.

Even the surgical treatment is not perfect and complication rates range

from 1.5 to 12.2%. The objectives of the study were to evaluate efficacy and

safety of hormonal cryptorchidism treatment by a systematically review of

the literature.

The authors analyzed randomised clinical trials (RCT) which compared

i.m. hCG vs. intranasal GnRH, intranasal GnRH vs. placebo, and i.m. hCG

in different doses and intervals of administration. They searched within

electronic databases and relevant medical journals, cross -checked refer-

ences of identified studies and contacted specialists. Randomization

process, blindness and description of withdrawals and dropouts were taken

into account to evaluate the quality of the RCT.

Three studies compared i.m. hCG vs. i.n. GnRH. Of 201 children were

analyzed, complete testicular descent was found in 25% vs. 18%. Nine trials

studied the use of i.n. GnRH vs. placebo. Of 1049 patients studied, complete

testicular descent was 19% vs. 5%. Only two studies on doses and intervals

of administration were selected. Data could not be pooled. Seven hCG

injections of 1500 IU on alternate days vs. four injections of 100 IU/kg every

4 -5 days had success rates of 51% vs. 51% for unilateral cryptorchidism,

48% vs. 50% for bilateral cryptorchidism. Ten hCG injections twice a week

with age adapted dosage vs. three injections every 7-10 days with higher age

adapted dosage resulted in a testicular descent of 19% vs. 17% for unilateral,

but of 26% vs. 11% for bilateral cryptorchidism.

The best existing evidence shows the advantage of hCG in usual doses

and intervals compared with GnRH and placebo or with higher doses and

larger intervals. But sample size, design and statistical power of the studies

are not adequate, and none reported the randomisation procedure and the

calculation of sample size. Therefore no sufficient evidence exists to recom-

mend hormonal therapy with hCG or LHRH. Better planned and executed

studies have to determine the real benefit of hormonal therapy. The inclusion

of the age of the boys at treatment is important.—P. Schmittenbecher

Primary lesicoureteric reflux—Our 20 years’ experienceZupancic B, Popovic LJ, Zupancic V, et al. Eur J Pediatr Surg 2004

(October);14:339-344.

The aim of this study was to compare the Lich-Gregoir procedure

and antireflux ureterocystoneostomy at the vertex of the bladder (AUVB),

based on 20 years’ clinical experience. A review was performed on l280

children operated on for primary vesicoureteric reflux, 368 bilaterally

which resulted in 1648 antireflux ureterocystoneostomies. Of the 1648

antireflux procedures, AUVB was performed in 1032 ureteric units and the

Lich-Gregoir procedure in 616 units. The final results were evaluated

2 years after the operation. Satisfactory results were achieved in 93.5%

with AUVB and 96% with the Lich-Gregoir procedure. The postoper-

ative failure rate was 6.5% for AUVB and 4% for Lich-Gregoir,

respectively. The recurrence rate was higher following AUVB (5%) than

Lich-Gregoir (1.5%), but postoperative stenosis was more frequent

following Lich-Gregoir (2.5%). Today, the authors prefer the Lich-

Gregoir procedure as method of choicer. Only if the results of the

Lich-Gregoir procedure prove unsatisfactory, AUVB is recommended for

recurrent operations. Finally, in cases of repeated VUR recurrence, an

antireflux ureteroileocystoplasty with an intussuscepted segment of ileum

is performed as the last option.—Thomas A. Angerpointner

Antenatal hydronephrosis: ureteral polyp causing ureteropelvicjunction obstructionMenon P, Kakkar N, Rao KLN. Eur J Pediatr Surg 2004 (October);14:

345-347.

The authors describe a rare case of ureteropelvic junction obstruction in a

3 1/2 year-old boy due to a benign ureteric polyp. This case is being

reported due to the rarity of benign neoplasms of the ureter in children, and

also because the child had been diagnosed antenatally as having hydro-

nephrosis.— Thomas A. Angerpointner

Outcome of valve ablation in late-presenting posterior urethral valvesSchober JM, Dulabon LM, Woodhouse CR. BJU Int 2004 (September);

94:616-619.

The records of 70 boys aged 2 to 14 years diagnosed late with PUV and

treated with value ablation were reviewed retrospectively. Patients were

followed for a mean of 25 months (range, 1-78 months). The most

common presenting symptom was voiding dysfunction; 48 (67%)

presented with nocturnal enuresis, 42 (60%) with urinary frequency,

and 12 (17%) with a history of urinary tract infection. Twelve (17%) had

mild age-corrected hypertension. Microhaematuria was present in

21 (30%). All patients had normal serum creatinine levels. Ultrasonog-

raphy showed hydronephrosis in 33 (47%) and a postvoid residual volume

in 57 (81%). On VCUG, 52 (79%) patients had clear evidence of PUV,

22 (31%) bladder trabeculation, 11 (16%) vesico-ureteric reflux, and

8 (11%) diverticula. On cystoscopy, 67 (96%) patients had the classic

sail - shaped PUV and three a ring-shaped valve. After valve ablation,

most dramatically improved; 31 (74%) of 42 had resolution of urinary

frequency, 24 (73%) of 33 of diurnal enuresis, and 17 (38%) of

47 nocturnal enuresis. Of 57 patients, 39 (68%) established good bladder

emptying. Of 33 affected, 20 (60%) had some reduction of hydro-

nephrosis, but 63% continued to have some symptoms of voiding

dysfunction. PUV should be considered in boys presenting with voiding

dysfunction.—M. N. de la Hunt