Objective To summarize the management of testicular tumors in children. Methods The clinical data of 55 children (age between 2 months to 12 years) with testicular tumors were retrospectively analyzed.Most of the children presented with painless scrotal mass.Of them 25 cases had yolk sac tumors,24 had teratomas,2 lymphomas,1 seminoma,2 dermoid cysts and 1 lymphangioma. Results Of the 55 cases 31(56%) were followed up with a mean time of 3 years.Among the 25 (68%) cases with yolk sac tumors 17 were followed up,of whom,9 were with stage Ⅰ and they underwent high amputation of spermatic cord with orchiectomy;one with stage Ⅳ and 3 with relaps of tumors who underwent chemotherapy and surgery were alive and well.Of the 14 cases with teratomas who were followed up,5 underwent enucleation of teratomas with retention of testiculi;and one with malignant teratoma underwent surgery.All of them are alive and free of tumor recurrence. Conclusions Children with testicular yolk sac tumors in stage I can be managed by orchiectomy alone,while those in stage Ⅱ-Ⅳ can be treated with a combination regimen of surgery and chemotherapy (PVB).Testicular-sparing enucleation surgery can be used in some benign testicular tumors.

Objective To evaluate various immediate managements of traumatic posterior urethral disruption in children. Methods 22 boys,2 to 14 years of age,with pelvic fracture and posterior urethral disruption were treated.There were 5 cases of partial urethral disruption,4 being managed by immediate suprapubic cystostomy and 1 by urethral catheterization.Of 17 cases of complete urethral disruption,6 underwent immediate suprapubic cystostomy with anastomosis of the disrupted ends later.The other 11 cases underwent primary urethral anastomosis via the perineum route. Results All the 5 partial disruption were cured without any complication.In 6 cases of complete urethral disruption with immediate suprapubic cystostomy,delayed repair was undertaken in 5. Of the 11 cases with primary urethral anastomosis,success and satisfactory result have been achieved in 10.Only 1 needed urethrostomy for further management. Conclusions For incomplete urethral disruption suprapubic cystostomy alone is indicated.For complete urethral disruption,primary urethral anastomosis via the perineal route would yield good result with much less chance of complications.

Objective To evaluate the use of Mitrofanoff principle in the field of pediatric urology. Methods From May. 1997 to Dec.1999,the Mirtofanoff principle has been used in 7 children to achieve CIC and urinary continence.The mean age of the patients at operation was 8 years (range 3～14 years).A catheterisable conduit was created using the appendix.Either the cecum,ascending colon or plus the terminal ileum were used instead of the bladder or for augmentation of the bladder after detubularization.7 children consisted of an 8 years old boy has lost his bladder,right ureter and bilateral testis due to traffic accident, 4 children with congenital complete urinary incontinence (urogenital sinus abnormality 1,extrophy of bladder after failed reconstruction 1 and shortened urethra 2),and neurogenic bladder 2. Results Immediate success has been achieved in 5 children (70%),who were completely continent and practiced successful CIC via the Mitrofanoff stoma. Conclusions Use of the Mitrofanoff principle is a valuable procedure for urinary diversion in childhood.

Objective To evaluate the risk urodynamic factors of upper urinary tract deterioration in children with neurogenic bladder dysfunction secondary to myelodysplasia. Methods Urodynamic and imaging studies were performed in 32 children with myelodysplasia. Results 18 patients had ureterohydronephrosis and 4 of them had vesicoureteric reflux.Of 19 children with detrusor leak point pressure higher than 40 cmH 2O and bladder compliance less than 40ml/cmH 2O, upper tract deterioration was revealed in 17.In contrast,of 13 patients with detrusor leak point pressure less than 40 cmH 2O and bladder compliance higher than 40 ml/cmH 2O, only one had bilateral ureteral dilatation( P

Objective To study the clinical features of adrenocortical carcinoma in children. Methods From 1983 to 1999, 9 cases of adrenocortical carcinoma were reviewed retrospectively. Results Six cases were surgically treated, complete tumor resection in four cases and palliative tumor resection in two.All were female. All the operated cases were followed up for an average of 2 years and 3 months.The 2 year survival is 4 out of 6. Conclusions Early diagnosis and complete tumor resection is the only means to achieve good survival in children with adrenocortical carcinoma.

Objective To present experience on the management of traumatic posterior urethral stricture or obliteration in boys. Methods Treatment included transurethral resection (TUR) in 112 cases,combined perineal-transpubic urethral repair in 44,via perineal approach for urethral repair in 32,perineal urethrostomy performed either transpubicaly or(and) via perineal approach or interposition of a segment of pediculated skin tube of scrotum in 20 cases,Mitrofanoff in one,urethra anastomotic repair through rectal and perineal approach in one. Results The whole series have been followed up for 6 months to 14 years.Normal urination was achieved in 187(89%),incomplete urinary incontinence in 17,still with perineal urethrostomy in 5,and intermittent catheterization needed in 1.Posterior urethral diverticulum with chronic epididymitis persisted in one. Conclusions Appropriate initial treatment is important for the management of traumatic posterior urethral injury.In fresh cases simple cystostomy was only carried out for incomplete urethral disruption,end to end anastomosis via suprapubic combined with perineal approach is indicated in complete urethral disruption.For old urethral injury,internal urethrotomy is good for the majority of simple stricture.Transpubic combined with perineal approach is indicated for the length of posterior urethral stricture or obliteration longer than 2 cm.If the proximal urethral end is long enough for exposure the urethra can be repaired via perineal approach alone. Perineal urethrostomy should be reserved for patients with long segment of urethral obliteration.

Objective To discuss the clinical and pathological features of malignant rhabdoid tumor of the ureter (MRTU).Methods One case of MRTU was reported, a six-year-old girl was admitted to our hospital on May 29, 2014, and presented left loin pain 2 weeks, ultrasound showed gradually progressing hydronephrosis and hydroureter.During a physical examination, she felt tenderness in the left kidney area and no mass was palpable in abdomen.The ultrasound showed left sided gross hydroureteronephrosis and a round hyperechogenic mass in the inferior pole of the left ureter (In front of the left iliac vessel), with no obvious borders.Contrast-enhanced CT suggested a gross dilatation of the left kidney and ureter with a solidappearing lesion in the lower ureter;neither additional abdominal abnormalities nor enlarged lymph nodes were seen in both examinations.The surgery began with incision of left lower abdomen.The partial ureter of neoplasm was excised along with invaded psoas and posterior peritoneum by gross inspection, then ureteroureterostomy was performed.The severed ureter was completely blocked with the ill-defined neoplasm and was 3.3 cm in length and 2.1 cm in width.Results The ureteral neoplasm was excised,along with the invaded psoas and posterior peritoneum,after that ureteroureterostomy was performed.HE showed the diffuse large round nuclei, vesicular chromatin, prominent nucleoli cells, and moderate amounts of eccentrically placed eosinophilic cytoplasm.Immunohistochemical studies were positive for cytokeratin, epithelial membrance antigen and vimentin, negative for INI1, METU hereby was confirmed.She underwent a chemotherapy regimen consisting of ICE, alternating with VDC.Four courses chemotherapy (3 months) later,CT scan suggested hematogenous metastasis of lung.The family refused further treatment and the patient died of systemic metastasis eight months after surgery.Conclusion MRTU was a rare and highly aggressive tumor with a poor prognosis.

Objective To investigate the experience of diagnosis and management of coexisting ureteropelvic junction obstruction (UPJO) and nonreflux megaureter (NRM).Methods The retrospective study of UPJO with NRM was based on 10 years information retrieved from January 2005 to December 2015.The data of 13 patients (8 males and 5 females) were available and recorded.Mean age at surgery was 3.7 years old (range 1.8 to 14 years).The diagnosis and mangement were summarized.Coexisting ureterovesical junction obstruction (UVJO) and vesicoureteral reflux,iatrogenic stricture and vesicoureteral reflux were excluded.Intravenous pyelography,voiding cystourethrography,ultrasound and CT reconstruction were performed before operation.Only six patients had an accurate diagnosis as UPJO with UVJO before surgery.Pyeloplasty was the initial surgical management choice for 10 patients,and ureteroneocystostomy in 3 patients.Results UVJO were diagnosed with pyelography techniques in 3 patients after pyeloplasty,while 4 were diagnosed as nonreflux and nonobstruction megaureter.Of the 10 patients who underwent initial pyeloplasty,additional ureteroneocystostomy was required in 3 and the prognosis was good.Additional pyeloplasty was required in 2 of the 3 patients who initially underwent ureteroneoeystostomy.Mean follow-up time from last operation was 23.3 months (6-53 months),the overall prognosis was good.Conclusions It is often difficult to correctly diagnose coexisting UPJO and NRM.In patients with UPJO,it is highly recommended nephrostomy radiography after pyeloplasty to evaluate the distal ureterovesical junction.Initial pyeloplasty is always recommended as first-line therapy.Additional ureteroneocystostomy was required when hydroureteropelvic was aggravated.

Surgical treatment of pelvic fracture-associated urethral injury(PFUI) continues to be a difficult problem to be solved in urology.Children with an immature prostate and puboprostatic ligament may suffer from posterior urethral disruptions in a manner different from adults.Considering these distinctions,the management of pediatric PFUI presents a challenge for urologist as no consensus or algorithm has been proposed or accepted.Now,through analyzing the pathogenesis,presentation,diagnosis and treatment of PFUI,give the principle of the management.The choice of immediate repair or delayed repair should be decided according to the particular situation.Immediate Ⅰ stage anastomosis of urethra for PFUI is recommended when the patient's condition is stable,serious complications are treated,and the surgeon is experienced.If the patient's condition is unstable or no experienced urologist is available,a suprapubic catheter should be placed for bladder decompression and try to get a good condition for delayed urethroplasty.

Objective To compare the treatment efficacy of severe hypospadias between two-stage urethral plate reconstruction procedure and two-stage tubularized transverse preputial island flap procedure. Methods From 2010 December to 2014 December, we retrospectively analyzed 82 cases with severe hypospadias, using two-stage urethral plate reconstruction and two-stage tubularized transverse preputial island flap urethroplasty, respectively.Their mean age in the first operation was 2.4 years, ranged from 2 to 3 years.Hypospadias were penoscrotal type in 32 cases, perineal type in 50 cases.In group A, 42 cases, including penoscrotal type in 15 cases, perineal type in 27 cases, with urethral plate reconstruction procedure underwent two-stage urethroplasty.The transected ventral penile urethral plate and to strip the ventral fibrous tissue were needed in correction of chordee of penis.The patients in group A were underwent the second urethroplasty with urethral plate reconstruction procedure 6-12 months later.In group B, 40 cases,including penoscrotal type in 17 cases, perineal type in 23 cases, who underwent one stage operation in the correction of chordee of penis, only with tubularized preputial island flap forming the part of the urethra.The patients in group B were underwent the second urethroplasty 6 ~12 months later.Results Patients were followed up for 1 to 5 years, mean 3.5 years.No recurrence of penis chordee was noticed.In group A, 6 cases (14.3%) had postoperative fistula.The second fistula repairing was perform 6 to 12 months after the second stage operation.However, still 3 cases were noticed the fistula recurrence, which was cured after the fourth operation.In group B, 3 cases (7.5%) developed fistula, which appeared in the second urethroplasty (P<0.01).They were all treated after the second repairing procedure.In group A, 4 cases were noticed urethral stricture, the urethral stricture rate was 9.5%.The stricture occurred 1 to 3 months after the second operation.After dilation and indwelling catheter, 3 cases resolved the problem. Another case still found the recurrence after 2 months, which the one stage urethral plication and second urethral reconstruction were considered to treat this patient.In group B, 1 cases of urethral stricture, the urethral stricture rate was 2.5%(P<0.01).After dilation and indwelling catheter, this case resolved the problem.In group A, 3 cases had urethral diverticulum, which occurred at a rate of 7.1%, whereas without urethral diverticulum occurred in group B (P<0.01).Those patient with urethral diverticulum accepted the diverticulum removing procedure 3 to 6 months after the second stage procedure.One case was found the urethral fistula, which was treated one year later.The success rate of operation was 69.0%in group A, the success rate of the operation was 90.0%in group B.The difference of the success rate between two groups was statistically significant ( P <0.01 ) . Conclusions With respect to two-stage urethral plate reconstruction procedure in treatment of severe hypospadias, there were the low complication rates of postoperative urinary fistula, urethral stricture and diverticulum in two-stage tubularized transverse preputial island flap procedure.Urethral meatus could be done at the glans of the penis.In addition, the two-stage tubularized transverse preputial island flap procedure provides a good opportunity to practice to master complex hypospadias operation.