Johnston Canyon, Banff
For Clinicians
Clinical Insight & Surgical Analysis (Clinical Pearls)
Commentary on recent papers and global guidelines, surgical technique analysis, and notes on the shifting practice trends in pediatric urology.
Johnston Canyon, Banff
For Clinicians
Commentary on recent papers and global guidelines, surgical technique analysis, and notes on the shifting practice trends in pediatric urology.
Goals and what counts as a good result, grading severity, urethral development, epidemiology and causes, and penile curvature.
Which of the three problems persists into adulthood — and what it means to decide it at the first operation.
Complication rate is not outcome — why patient, surgeon and parent scores diverge, and what the GMS score revealed.
Meatal position does not determine severity — the GMS score, its validation, and the finding that only curvature survived.
The double zipper — canalization, then androgen-dependent fusion — why the glans differs, and why a dorsal hood comes with 95% of cases.
A nineteen-fold spread between registries and what drives it, and the weight of evidence behind each proposed cause.
Reading curvature as structure rather than angle — four contributing factors, explanations that ran in parallel rather than replacing one another, and the dysplastic ventral tissue that does not divide into layers.
Where 30° is actually used, artificial erection repeated after every step, the path from plate preservation to transection, and how the threshold for transection changed over the last decade.
Embryology and the two routes of renal damage, spontaneous resolution, post-pyelonephritic scarring, and the long-term course of a small kidney.
Where the ureteric bud arises sets the orifice, the tunnel and the kidney all at once. Paquin's 5:1, and the two routes to renal damage.
Resolution is not the crossing of a single number. Rates by grade, the grading variability shown by RIVUR, and the ureteral diameter ratio that complements grade.
How papillary shape alters intrarenal reflux, the balance between clearing bacteria and injuring tissue, scars that mature after microbiological cure, and the risk a second febrile infection changes.
The long-term course of congenital hypodysplasia and post-infectious scarring: compensation and hyperfiltration, split function versus total GFR, trends in proteinuria, blood pressure and puberty, and follow-up after reflux resolves.
How views on pathogenesis have shifted, prognosis, choosing the operation by testis position and situation, and preserving the gubernaculum in two-stage surgery.
From hormonal theory to structural theory, and the real prognosis by paternity rate — unilateral vs. bilateral.
Approach selection, laparoscopy indications, atrophy rates in single- vs. two-stage surgery, diagnostic laparoscopy, and the Shehata technique.
Arterial and venous anatomy, collaterals after ligation, the sparing technique, and what comparative and randomised studies show.
Terminology, aetiology, classification and penile size; indications, timing and technique.
Why the terms never converged, why observations of aetiology contradict each other, and the under-recognised gray zone of penile size.
Deciding without a guideline, the common principles of technique and their limits, and how the author's technique changed.