For these posts, I go through every article from the issue; I comment on the ones that taught me something new or will change the way I practice.
Higher prevalence of homosexual and bisexual orientations in patients with CAH
This compilation of different studies showed a greater prevalence of homosexuality and bisexuality among patients with congenital adrenal hyperplasia. About 3% of people in the United States consider themselves homosexual or bisexual; among CAH patients, the prevalence appears to be around 15%. The more virilization or the salt-wasting variant increases the risk of non-heterosexual behaviour.
Low risk of hypertension or malignancy in patients with multicystic dysplastic kidneys (MCDK)
The risks of hypertension or malignancy are similar in patients with MCDK compared to the general population according to this meta-analysis. The authors suggest a very reasonable algorithm for the follow up of these patients:
- Ultrasound at 3 months, 1-2 years, and at puberty.
- Yearly blood pressure and urine-analysis (to check for proteinuria).
Ultrasound monitoring is for checking on the contralateral kidney and the involution of the MCDK — and not for malignancy screening.
Must-watch videos of the delayed Kelly procedure for bladder exstrophy closure without osteotomies
Beautiful dissection, bloodless field, flawless technique, and a clear demonstration of the need to separate the urethra from the penis to increase penile length, make these must-watch videos.
I also have to comment on any article that challenges the status quo.
The status quo in bladder exstrophy used to be immediate neonatal closure and emphasis on pelvic ring closure to prevent dehiscence. This surgical series challenges both concepts by performing delayed closure without osteotomies in 27 patients with no cases of dehiscence. There were however several complications including stenosis, fistula, hernia, and recurrent VUR.
On the commentary to the article, Rosch states that complete bladder and urethral plate dissection from the pubic rami is the key to prevent dehiscence –and not pelvic ring closure. The one potential downside to leaving the symphysis open is the long-term potential for abdominal wall issues and pelvic organ prolapse.
In my opinion, the jury is still out there regarding the best method to close bladder exstrophy. For now, I will continue to do the same.
Nurse practitioners doing circumcisions in the OR
Nurses practitioners performed 90 circumcisions with only indirect supervision, with no complications. When pediatric urologists do circumcisions, they are not practicing at the top of their license. Having nurse practitioners do circumcisions in the OR is the best idea since sliced bread.