Utricular Configuration in Hypospadias and Intersex

Devine, Charles J.; Gonzalez-Serva, Luis; Stecker, John F.; Devine, Patrick C.; Horton, Charles E.

doi:10.1016/s0022-5347(17)55959-5

Cited by 112 publications

(65 citation statements)

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“…1,2 These abnormalities of the genitourinary tract may be seen in normal boys rather than in those with hypospadias and intersex disorders (mixed gonadal dysgenesis and true hermaphroditism). 3 Although the embryogenetic difference between EPU and MDC is still controversial, from a clinical point of view these entities are well defined.…”

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confidence: 99%

“…4 EPU is a tubular shaped structure communicating with the urethra that is frequently observed in younger patients in association with hypospadias, intersex disorders or other anomalies (prune-belly syndrome, posterior urethral valves, Downs syndrome and imperforate anus). 1,3,5 EPUs are commonly identified while performing voiding cystourethrography (VCU) or cystoscopy. When other mü llerian structures (cervix, uterus or fallopian tubes) are present, this complex is better defined as vagina masculina.…”

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Laparoscopic Removal of Müllerian Duct Remnants in Boys

et al. 2004

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Purpose: Mü llerian duct remnants (MDRs) are present in a male pseudohermaphroditic form characterized by failure of the mü llerian duct to regress due to insufficient production or peripheral action of mü llerian inhibiting substance. The MDR can be asymptomatic but it often results in infections, stones and voiding troubles. Furthermore, it may develop into a neoplasm. Therefore, surgery is mandatory for large MDRs and symptomatic patients. Laparoscopic removal is described.Materials and Methods: Six males were treated from February 1998 to February 2003. Age at surgery was between 3 and 18 years (mean 8.6). All patients showed severe hypospadias and 2 had mixed gonadal dysgenesis with ambiguous genitalia. Three patients presented with urogenital infections and all had a large MDR. Laparoscopic procedures, which were preceded by cystoscopy, were performed using a 10 mm umbilical trocar for the camera and 3, 5 mm trocars for instruments placed in the suprapubic region and iliac fossa bilaterally. The remnants were ligated with endoscopic loops or an endoscopic GIA stapler and cut.Results: Mean operative time was 2 hours. We noted no complications. In 2 cases there was deferential ectopia and in another of mixed gonadal dysgenesis bilateral gonadectomy was performed because of the risk of degeneration. Feeding started on postoperative day 1 and the patients were discharged home on day 5. After a followup of 8 months to 4 years all boys were healthy.Conclusions: Multiple approaches are used in traditional surgery, often leading to complications. Laparoscopy improves the view, decreases surgical risk and operative time, avoids large scars and allows more rapid hospital discharge.

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Laparoscopic Removal of Müllerian Duct Remnants in Boys

et al. 2004

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“…Çalışmamızda klinik bulguları oluştu-ran idrar yolu enfeksiyonu, üriner obstrüksiyon, enürezis, hematüri, ürolitiyazis ve tekrarlayan epididimit literatür verileriyle uyumludur (4,7,10). PU ve VM adölesan dönem ve sonrasında infertilite, kistleşme, kalsifikasyon ve karsinoma gelişimi gibi komplikasyonlara yol açabil-mektedir (7,(16)(17).…”

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“…PU'lerin çoğu asemptomatik olmasına karşın tekrarlayan idrar yolu enfeksiyonu (İYE), taş oluşumu, üriner obstrüksiyon, hematüri, enürezis ve tekrarlayan epididimite neden olabilir. İnfertilite, kistleşme, kalsifikasyon ve neoplastik dejenerasyon gibi komplikasyonlara yol açabilir (3)(4)(5). Tanıda ultrasonografi (USG), retrograd üretrog-rafi, işeme sistoüretrografisi ve sistoskopi kullanılabilir (6)(7)(8)(9).…”

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Hipospadiyas ve İnterseks Olgularında Prostatik Utrikül Konfigürasyonu Prostatic Utricle Configuration in Hypospadias and Intersex Patients

Levent;ÇİFTÇİ¹

2007

Ankara Üniversitesi Tıp Fakültesi Mecmuası

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Amaç: Hipospadiyas ve interseks olgularında prostatik utrikül (PU) sıklığı, klinik karakteristikleri, tedavi metodları ve izlem sonuçlarını değerlendirdik.Gereç ve Yöntem: Hipospadiyas (n:72) ve interseks (n:108) tanılarıyla tedavi edilen, radyolojik ve endoskopik incelemelerle PU varlığı araştırılan hastalar retrospektif olarak incelendi.Bulgular: PU sıklığı hipospadiyas olgularında %12.5, interseks olgularında ise %22.2 bulundu. Her iki grupta en sık görülen klinik semptomlar üriner enfeksiyon, üriner obstrüksiyon, enürezis ve ürolitiyazisdir.Sonuç: İnterseks ve ağır hipospadiyas olgularında PU varlığı radyolojik ve endoskopik yöntemler-le araştırılmalıdır. Cerrahi tedavide ana amaç üretra, mesane boynu, sfi nkterler ve pelvik sinir ağına zarar vermeden, büyümüş PU yapılarının tümüyle çıkartılmasıdır.Anahtar Kelimeler: Hipospadiyas, interseks, prostatik utrikül. Aim:A retrospective clinical trial was performed to evaluate prostatic utricle (PU) incidence, clinical characteristics, treatment and follow-up outcomes in hypospadias and intersex patients.Material and Methods: Hypospadias (n:72) and intersex (n:108) patients in whom the confi guration of PU were evaluated by radiological and endoscopic investigations. Results:The incidence of PU was 12.5% and 22.2% in hypospadias and intersex patients. Urinary infection, obstruction, enuresis and urolithiasis were the most common clinical symptoms in both groups.Conclusion: PU should be evaluated by radiological and endoscopic investigations in intersex and hypospadias patients. The main goal of surgical therapy is total excision of extended PU structures without damaging to urethra, bladder outlet, sphincter and pelvic plexuses.

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“…It is thought to be of mixed origin, with its cranial portion derived from the Müllerian duct and the caudal segment from the Wolffian duct and urogenital sinus. The classical description of an enlarged PU is a congenital dilated fluid-filled cavity posterior to the prostatic urethra, which may be detected in 11-14% of male infants with hypospadias and in 16.6% of boys presenting with intersex abnormalities and cryptorchidism 1,2 . The most prominent complications consist of recurrent urinary infection and obstruction, stone formation in the pouch, dysuria, back-pressure changes and pseudo-incontinence due to secondary trapping of urine in the pouch, and occasionally xanthogranulomatosis or malignant degeneration.…”

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