Objective: To evaluate safety and efficacy of a novel method of bilateral patent processus vaginalis ligation in transumbilical single-site multiport laparoscopic orchiopexy for children. Methods: A retrospective study was carried out comparing the novel ligation and conventional ligation performed by a single surgeon between July, 2017-July, 2018. The patients were divided into the novel group (42 cases) and the conventional group (59 cases). In the novel group, transumbilical single-site multiport laparoscopic orchiopexy was performed and the bilateral internal rings was stitched with "8" pattern suture. In the conventional group, the conventional TriPort laparoscopic orchiopexy was performed and purse string suture was used to fix the internal rings. The parameters of operative duration time, postoperative hospital stay; postoperative complications were compared between 2 groups. Results: All operations were successful. No Perioperative period complications were found and all patients were discharged within 4-6 days after operation. There is no statistic difference in the surgery time and hospitalization day. However, there is significant difference in the Pain face scale scores after day 2(1.60±0.73 VS 2.02±0.86). And there is no scar and the satisfactory cosmetic could be seen in scrotum and inguinal area in the novel group. Conclusion: The novel ligation was safety and efficacy. It is relatively easy to perform with smaller scar and less pain. We propose the novel ligation as a more viable treatment option for pediatric cryptorchidism with bilateral patent processus vaginalis.

Technical considerations of urethral surgery in children are critical because of the small size and delicacy of the urethra. From 1984 to 1989, children ages 4 to 14 years with serious traumatic urethral strictures (n = 5) or occlusion (n = 5) were treated. For anterior lesions, transurethral resection (TUR) with a Storz urethroresectoscope (10F-15F) was used to excise all scar tissue after the stenotic tract had been incised or dilated. For lesions in the posterior urethra, the bladder was opened or the cystostomy tract dilated, allowing the operator's index finger to be passed to the posterior end of the lesion while an assistant's finger was inserted into the patient's rectum. A sharp-tip 4F sound was then guided up the urethra into the bladder, the lesion was dilated, and the scar tissue was excised. With an average of 24.4 months of follow-up, success was achieved in all patients, requiring one session in seven patients and two or three sessions in the others. Recurrences in three patients were cured by repeat TUR. There were three cases of epididymitis and two of scrotal edema. This procedure is recommended as the treatment of choice for children with urethral strictures or occlusions. Thorough clearance of scar tissue is valuable to enhance the cure rate.

ObjectiveTo explore a novel repair method for proximal hypospadias with incomplete penoscrotal transposition in children and evaluate its safety and outcomes.MethodsA retrospective analysis of clinical data was conducted for 86 children with severe proximal hypospadias with incomplete penoscrotal transposition who were hospitalized in our department between June 2018 and February 2021. In total, 42 patients (Group A) underwent repair following a one-stage method in which tunica vaginalis flap-covering was combined with a modified Glenn–Anderson procedure, while 44 patients (Group B) underwent a two-step repair consisting of tunica vaginalis flap-covering using the Duplay technique and the modified Glenn–Anderson procedure. The two groups were compared on operation time, length of postoperative hospital stay, postoperative complications, and associated costs.ResultsAll operations were successful in both groups. No statistical difference was observed between the two groups in incidence of stenosis of the urinary meatus (2.38% vs. 4.54%, P = 0.279), urethral stricture (2.38% vs. 2.27%, P = 0.948), urinary fistula (7.14% vs. 6.82%, P = 0.907), or urinary infection (7.14% vs. 4.55%, P = 0.309). Additionally, there was no statistical difference between the groups in operation time (63.21 ± 5.20 vs. 62.07 ± 4.47 min, P = 0.059), postoperative off-bed time (7.02 ± 1.32 vs. 6.84 ± 1.20 days, P = 0.456), or duration of hospitalization (10.55 ± 1.15 vs. 10.15 ± 1.45 days, P = 0.092). However, Group B patients underwent an additional second-stage operation, incurring extra costs. Three months after surgery, Group A were judged more positively on the PPPS (specifically receiving higher scores on shaft skin and general appearance) by both the parents (shaft skin: 2.10 ± 0.82 vs. 1.93 ± 0.62, P = 0.024; general appearance: 2.16 ± 0.91 vs. 1.93 ± 0.72, P = 0.042) and the surgeon (shaft skin: 2.42 ± 0.70 vs. 2.25 ± 0.58, P = 0.025; general appearance: 2.38 ± 0.69 vs. 2.29 ± 0.51, P = 0.041). In most cases, the parents and surgeon were satisfied with the appearance of the genitals after one-stage repair.ConclusionThe advantages of the novel repair technique include use of a single-stage operation, producing a better appearance at a lower cost. The tunica vaginalis flap-covering method is not only demonstrated to be safe and effective, but it is also a simpler method than the conventional operation.

Background: Left paraduodenal hernia (PDH) is a mesenterico-parietal hernia with retroperitoneal retrocolic herniation of the small bowel into a sac formed by a peritoneal fold located near the fourth portion of the duodenum. It’s a rare cause of hydronephrosis by compressed the upper left ureter. Traditionally, PDH are treated by laparotomy.Case presentation: An 8-year-old boy’s primary purpose was the treatment of cryptorchidism. But hydronephrosis was detected and it was induced by left paraduodenal hernia. Diagnostic laparoscopic exploration confirmed the diagnosis left paraduodenal hernia secondary hydronephrosis. Cryptorchidism was the primary purpose of treatment. The patient was treated with laparoscopic surgery, fixed left paraduodenal hernia, released the ureteropelvic junction obstruction (UPJO) and treated hydronephrosis.Conclusion: Secondary surgery for treating cryptorchidism would be performed and the long-term follow up was necessary.This case suggests us a rare cause of hydronephrosis in children. Every why has a wherefore. We must pay much attention to any unusual details in our medical work even though these details aren’t related to our primary objects.