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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Ureteral reflux in various degrees is seen in 100% of cases after closure. A preoperative ultrasound evaluation of the otherwise usually unaffected upper tracts is mandatory to determine the presence of two normal kidneys"

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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The confluence is not always readily apparent, especially in very masculinized patients who have a UGS resembling a male urethra. In these patients, one must actively look for a verumontanum-like structure with a small “utricular” opening in the proximal urethra. This is the confluence. A guidewire or ureteral catheter should be inserted into this communication through the cystoscope, and then the scope can be passed over the guide into the vagina. In almost all cases, we find it helpful to place a Fogarty catheter into the vagina and inflate the balloon (Fig. 68.1). Even in the smallest neonate, this can be done by passing the Fogarty catheter through the cystoscopic sheath and clamping the catheter with a hemostat after the balloon is inflated."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Rink et al. described the “PVE” classification, in which the length and width of the phallus (P) is measured in centimeters, the location of the vaginal confluence (V) is recorded in centimeters from the bladder neck and from the UGS opening, and the degree of masculinization of the external genitalia (E) is estimated with a Prader number of 1–5."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The testis fails to remain in the scrotum in a significant number of older boys. They appear to have acquired cryptorchidism, which has been called ascending testis, gliding testis, or pathologically retractable testis. The abnormality is likely secondary to failure of the spermatic cord to elongate in proportion to the boy himself. (The spermatic cord length doubles from 5 cm to 8–10 cm in the first 10 years after birth.) At surgery, the major finding is a fibrous remnant of the obliterated processus vaginalis, linking acquired UDT with inguinal hernia. Occasionally the processus is still patent as a latent hernia. The indication for surgery in this acquired group is failure of the testis to remain in the scrotum without traction."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Consensus is building that the crucial step in postnatal germ cell maturation is transformation of neonatal gonocytes into type A spermatogonia in the second 6 months after birth; hence the current recommendation for orchidopexy is at 6 months of age. Prevention of germ-cell loss is the aim of surgery, although this effect remains unproven."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Circumcision of the visible external prepuce in these cases does not achieve emergence of the penis and may compromise the eventual reconstruction of a more normal circumcised appearance. An operation for this condition, to release the tethered corpora and remodel the shaft skin,"

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The buried penis is an abnormality of peno-scrotal fusion, in which the penile corpora are also tethered to the deep fascia of the lower abdominal wall. It is associated with phimosis, and the appearance of the external skin suggests that the penis is small or even absent. Often the inner preputial space is enlarged and balloons during voiding, with dribbling from the preputial orifice—referred to as megaprepuce."

Collection of superficial parotidectomy operative photos from colleagues at Pediatric surgery unit, Menofia university hospitals, Egypt

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The late sequelae of ureteroneocystostomy continue to be studied. A disadvantage of the transtrigonal technique is that subsequent endoscopic ureteral manipulation is difficult if an upper tract ureteral calculus occurs, whereas the ureteral orifice is in normal position with the detrusorrhaphy and Politano-Leadbetter techniques"

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The success rates of the P-L and the Cohen (transtrigonal) techniques are similar. The advantage of the P-L is that the ureter is much easier to catheterize for retrograde pyelography and ureteral endoscopy because the ureteral opening of the Cohen is on the opposite side of the bladder. The disadvantage is that in creating the new ureteral hiatus, there is a blind spot behind the bladder, and a peritoneotomy or even bowel injury may occur, particularly in reoperative cases."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Medical management is based on the principles that VUR often diminishes or resolves over time, and maintaining sterile urine minimizes the risk of reflux nephropathy. Medical management includes bladder training (encouraging regular micturition and treating symptoms of bladder/bowel dysfunction) and possibly antibiotic prophylaxis with a daily dose of an antimicrobial such as nitrofurantoin, trimethoprim, or sulfatrim. Many children undergo regular follow-up assessment with a voiding cystourethrogram (VCUG) and renal ultrasonogram (US) every 12–18 months. Medical management is continued until the VUR resolves or improves sufficiently that the VUR no longer seems clinically significant. Many clinicians consider grades I and II VUR to be benign.

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "In those patients who had prenatal diagnosis of hydronephrosis, ultrasonography is performed in the first week of life. If hydronephrosis is confirmed, radionuclide studies are undertaken when the child is 6–8 weeks old in order to assess renal function and rule out obstruction. In those patients who present with clinical symptoms, a renal ultrasound is performed, and if it shows hydronephrosis without dilated ureters, the diagnosis is confirmed with radionuclide studies. The most commonly used radionuclides are diethylenetriamine pentaacetate (DTPA) and mercaptoacetyltriglycine (MAG3). Because MAG3 is excreted mostly by the renal tubules and yields better images in infants with compromised renal function and immature kidneys, we and others prefer to use traces with a high extraction rate (such as MAG3) in patients with hydronephrosis."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The generally recommended pressures for insufflation are 15 mm Hg in adolescents (>10 years), 10–12 mm Hg in children (2–10 years), and 8–10 mm Hg in infants (0–2 years); these levels produce minimal physiologic effects. Children typically have a smaller and more compliant anterior abdominal wall than adults, limiting the working space during insufflation. Their peritoneal cavity does not accommodate more than 1–2 L of pneumoperitoneum, compared with 3–5 L in adults. Because of the higher compliance of their anterior abdominal wall, increasing the IAP above these recommended levels does not increase the working space."

quotes from "Pediatric Colorectal Conundrums: Case Studies: From Fundamental to Advanced (Pediatric Colorectal Surgery)" by Marc Levitt, Thomas Xu, Hussein Wissanji - "In addition, females with an ARM should have a gynecologic exam. This is often performed initially with a physical exam to confirm the presence of a vaginal opening. If the vaginal opening is absent, a pelvic US can be performed to assess intra-abdominal gynecologic structures and guide planning of reconstruction." "At the time of anorectoplasty, a vaginoscopy can be performed to identify the presence of a vaginal septum and characterize the number and location of the cervix or cervices. If the vagina is absent on exam, a diagnostic laparoscopy can be performed to determine if Müllerian structures (upper vagina, cervix, uterus, and Fallopian tubes) or the ovaries are present. This information is valuable for counseling the family and can influence possible gynecologic reconstruction options either at the time of the initial repair or in the future, at the time of thelarche or later in life."