While the most common cause of surgical cancellation is patient illness, a significant number of cancellations are preventable. These findings suggest that future targeted hospital interventions, including improved evaluation of insurance status and preoperative parental education regarding preoperative requirements, may improve operating room use.

Ventriculoperitoneal (VP) shunt surgery is the most common technique used in the treatment of hydrocephalus. Erosive bladder perforation is an extremely rare complication of VP shunt surgery. Only 2 cases of erosive bladder perforation by a peritoneal catheter have been reported in the English literature. The authors present the case of a 14-year-old male with a history of cerebral palsy, severe developmental delay and hydrocephalus who presented with VP shunt tubing protruding from his urethral meatus. The patient had no evidence of neurological change. The VP shunt had been last revised over 11 years prior to admission. Imaging demonstrated the VP shunt to be intact, but displaced inferiorly, with the ventricular catheter in the extracranial soft tissue of the neck and the peritoneal catheter passing into the abdomen, bladder, and out through the urethra. Shunt removal was achieved through a multidisciplinary approach, involving both neurosurgery and urology teams. The authors discuss other reported cases of perforation by a VP shunt, potential mechanisms, and considerations for management of this rare complication.

Scrotal calcinosis is a rare condition with presentation including intradermal nodules varying in size and number. Differentials include calcification of epidermal or pilar cysts noted by the presence of keratinaceous debris. We present 2 cases of scrotal calcinosis at our institution. IntroductionIdiopathic scrotal calcinosis (ISC) was first described in 1883 by Lewinski. 1 The clinical presentation of ISC includes gradual growth of brown-yellow, firm solitary or multiple nodules on the scrotal skin. This rare, benign condition of uncertain etiology typically begins in adolescence or early adulthood and occurs in the absence of abnormalities in calcium and phosphate metabolism. 2 The intradermal nodules tend to increase in size and number over time and can produce a white, chalky material. While these lesions are usually asymptomatic, some patients report pain and itching and there have also been reports of infection associated with ISC. Indications for surgery include relief of symptoms and preservation of scrotal cosmesis. The only treatment recommended for ISC is surgery, which allows for pathologic confirmation of the disorder. 3 We present 2 cases of this rare pathology treated surgically, as well as review of the current literature. Case 1A 22-year-old male was referred to the urology clinic with a 2-year history of asymptomatic scrotal nodules that had gradually increased in size and number. He denied history of scrotal trauma; he also had no history of any metabolic, systemic, neoplastic or autoimmune disease. The increasing number and size of the nodules were affecting his quality of life. He reports that he has avoided intimate relationships because he is embarrassed of his scrotal lesions. He also described increased itching secondary to the lesions. On physical examination, the patient was healthy and in no acute distress. The only significant findings on exam were multiple palpable dark yellow and brown subcutaneous nodules on the scrotum with no pain on palpation. The calcified nodules involved most of the entire scrotum (Fig. 1). His clinical findings were consistent with the working diagnosis of ISC. These lesions were confined to the scrotum with no other skin lesions elsewhere. His testes were palpably normal. Laboratory evaluation revealed a normal serum calcium, phosphorus and parathyroid hormones level.The patient was taken to the operating room where general anesthesia was administered. The involved scrotal skin was excised using multiple elliptical incisions to preserve some uninvolved skin to allow for adequate coverage for skin closure. The scrotal skin excised did not involve the dartos fascia. Several smaller calcifications were also excised individually. All of the defects were closed using 4-0 chromic suture in an interrupted fashion. The patient has not experienced any postoperative complications to date and he has fortunately had a good scrotal cosmetic outcome (Fig. 2). Pathologic analysis revealed extensive large and small dermal calcium deposits with fibrosis, epiderm...