Kramer, Stephen A.

The Section on Urology of the American Academy of Pediatrics met for 2½ days in conjunction with the 58th Annual Meeting of the Academy in Chicago, IL, October 21 to October 23, 1989. The papers presented at this meeting that were thought to be of interest to the practicing pediatrician are summarized here according to topic. The recipient of this year's Pediatric Urology Medal is Jack Lapides. Dr Lapides is recognized for his numerous academic achievements and his excellence in teaching as Professor and Chairman of the Department of Urology at the University of Michigan. His introduction and popularization of intermittent self-catheterization has revolutionized the treatment of neurogenic bladder dysfunction and is clearly one of the most significant contributions to urology during the past few decades. GENITOURINARY TUMORS Those of us involved in the care of patients with Wilms tumor continue to search for prognostic indicators which will allow identification of patients at low risk or high risk for the development of metastatic disease. The accumulated data from National Wilms' Tumor Studies II and III showed that decreasing amounts of chemotherapy can be administered to patients with favorable prognostic factors, whereas patients with poor prognostic factors require more aggressive chemotherapy and radiation therapy. While favorable histology and the absence of nodal metastatic disease have clearly been shown to be associated with enhanced survival, Gearhart and coworkers have used nuclear morphometry to predict response to treatment in patients with Wilms tumor. In a retrospective analysis of 29 patients with Wilms tumor, morphometric nuclear analysis (using several shape descriptors) was very useful in identifying responders vs nonresponders to chemotherapy.

Testicular torsion is the most common cause of acute scrotal pain in prepubertal and adolescent boys and should be foremost in the minds of primary care physicians evaluating these children. Intermittent testicular torsion is a separate entity that should be considered in all young males with a history of scrotal pain and swelling. Acute and intermittent sharp testicular pain and scrotal swelling, interspersed with long intervals without symptoms, are characteristic. Physical findings may include horizontal or very mobile testes, an anteriorly located epididymis, or bulkiness of the spermatic cord from partial twisting. Awareness of this entity and early elective orchiopexy will improve testicular salvage in patients with intermittent testicular torsion.