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How to Reduce Time Delays in Presentation and Treatment of Testicular Torsion; the Role of Public and Practitioners Education

Author: Saad Dakhil Farhan Daraji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 4 Pages: 499-503
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Testicular torsion (TT) requires prompt diagnosis and treatment to avoid testicular Loss. Most studies have focused on the ideal work up to rule TT out in cases of acute scrotum. A long response time to the scrotal pain was related to high orchidectomy rate during surgery for acute torsion.OBJECTIVE:We attempted here to highlight the causes behind high orchidectomy rate during the surgery for testicular torsion and the advices to decrease this problem.PATIENTS AND METHODS: Surgical exploration which was done for suspected testicular torsion in 50 consecutive males with their age (range 1-20 years. All patients were evaluated with detailed history, physical examination and Basic Laparotory investigations, some patients underwent scrotal ultrasound scan with color-Doppler preoperatively when possible. Patient age, site of pain, duration of symptoms, ultrasound finding, approximate time from admission to surgery, operative findings, and type of the operation and causes of delay for orchidectomy group were recorded.RESULTS: Intra operative Testicular torsion was documented in 36 patients, orchidectomy and orchidopexy was performed equally, Delays to reach the hospital for more than 4 hours after the onset of pain significantly associated with increase the risk of orchidectomy .The risk of orchidectomy significantly increased with increased patient age. Parents neglect appear the most important cause for small age group while self ignorance, social fear and false medical advices for older ages.CONCLUSION: A long response time to the scrotal pain and a high orchidectomy rate were exposed by this study. This was thought to be due to ignorance, which could be eliminated through public education.


Article
The Outcome of Two Modes of Treatments in Patients with Posterior Urethral Valve

Author: Saad Dakhil Farhan Daraji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 2 Pages: 203-208
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: The obstructive effect of the posterior urethral valve (PUV) can manifest along a spectrum of severity, ranging from disease incompatible with postnatal life to conditions that have such minimal impact that they may not manifest until later in life.OBJECTIVE:: To compare the outcome of patients with PUV underwent both techniques of PUV incision and primary urinary diversion (with a delayed PUV incision). PATIENTS AND METHODS:A prospective and retrospective study of twenty-eight children with posterior urethral valve was conducted. Details of age, presenting symptoms, serum creatinine, ultrasound and Voiding cystographic (VCUG) findings, the presence or absence of vesicoureteric reflux and the type of surgical interventions done were recorded. On the follow-up between 1- 2 year period, the patients were assessed by progression of the clinical state, biochemical analysis and ultrasound of the abdomen. Outcomes of surgery and further surgical intervention also assessed in addition to the assessment of the bladder function for older children.RESULT: The primary treatment of the PUV was with incision of the PUV in 13 cases (46.4%) while the primary treatment with urinary diversion and delayed incision of the PUV was performed in 15 cases (53.3%). A posterior urethral valve incision was cured in 46% of patients, while the primary diversion and the delayed incision operation was cured in 26.6%; Most of the patients (60.7%) still needed further urological intervention. There was no statistical significance between the results of both surgical procedures. Renal impairment and poor bladder function were more common with diversion operation.CONCLUSION: There is no convincing evidence to support any procedure as a way of improving long-term renal function or long-term bladder function. Therefore, urinary diversion is to be considered in selected cases with clear goals and endpoints in mind as it has an important place in the management of boys with PUV.

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