The Section on Urology of the American Academy of Pediatrics met in session in conjunction with the 49th Annual Meeting of the Academy in Detroit. Several areas of interest to the urologist and the pediatrician were discussed, and they included: hypospadias, urodynamic assessment of obstruction, vesicoureteral reflux, the management of urinary infection in children, cryptorchidism, and testicular neoplasms. This brief report is an attempt to summarize pertinent aspects of these topics that would be of help and interest to the practicing pediatrician.
Until fairly recently, the emphasis in hypospadias surgery was on functional reconstruction, and a subglanular meatus was felt to be satisfactory. However, newer techniques,1-3 improved suture materials and the popularization of optical magnification have recently allowed for more cosmetically normal reconstructions. Of interest during this year's discussion of hypospadias was the observation that all authors stressed the potential and desirability of achieving a cosmetically normal, glanular meatus. In fact, three of the four papers discussed the reconstruction of distal hypospadias—a meatus at the coronal margin with little or no chordee. In the past, parents were advised that surgery was unnecessary for these mild lesions because there was no limitation of function. Wacksman4 described a modification of a meatal-based skin flap for reconstruction of these lesions with a low complication rate—no fistulae and one meatal stenosis in 15 procedures.
One of the limiting factors in encouraging the reconstruction of a mildly hypospadiac, but functionally satisfactory urethral meatus, is the need for several days of indwelling catheterization and the risk of surgical complications—fistulae and strictures.
- Copyright © 1982 by the American Academy of Pediatrics