Vol. 181, No. 4, Supplement, Sunday, April 26, 2009 174 THE JOURNAL OF UROLOGY ® the boys after varicocelectomy. CONCLUSIONS: More than half of the total number of boys with grade 1 varicocele showed normal testicular development, whereas many boys presented growth delay in the bilateral testes. Grade 1 varicocele should be closely followed up at least annually to detect the testicular size discrepancy, which is one of the available indicators to perform varicocelectomy. Source of Funding: None 484 THE JONES APPROACH TO THE CORRECTION OF ABDOMINOSCROTAL HYDROCELES Shahab Hillyer*, Brooklyn, NY; Paul Zelkovic, Lori Dyer, Israel Franco, Tarrytown, NY INTRODUCTION AND OBJECTIVE: Abdominoscrotal hydroceles (ASH) can present a formidable surgical challenge even to an experienced surgeon. They are extremely difficult to correct due to the complex nature of the hydrocele looping back through the internal ring back into the abdomen. This makes identification of the hernia opening difficult at times. We have utilized the Jones preperitoneal approach to handle these hydroceles with improved success. METHODS: We operated on 11 hernias in 7 patients ranging in age from 6 months to 1.5 years. All patients were males, 6 were on the left side and 5 were right sided. Surgical exploration was performed via an inguinal incision and the external inguinal ring was exposed. An incision was made superior to the hydrocele at the level of the internal ring. The muscle layers were split and the hydrocele was identified as it entered the internal ring. The Vas and vessels are then isolated extraperiotneally and tagged. The hydrocele is then dissected from the retro peritoneum and drained. The sac can be followed into the internal ring. The hernia defect can be closed from the inside. The excess hydrocele sac is excised and the testis inspected. If there is a need the testis can be fixed in the scrotum in a subdartos pouch. RESULTS: All patients had and excellent result with a marked reduction in operative time and a decrease in the manipulation of the cord structures. There was no evidence of testicular atrophy noted in any of the patients. CONCLUSIONS: This appears to be an improved approach to the abdominoscrotal hydrocele minimizing the risk of injury to the vas and vessels during the dissection of the large, redundant sac which is commonly encountered in these cases. Intraoperative times is significantly reduced compared to standard inguinal techniques. Source of Funding: None 485 LAPAROSCOPIC EVALUATION OF CONTRALATERAL PATENT PROCESSUS VAGINALIS IN GIRLS WITH INGUINAL HERNIAS Kevin Feber*, Lane S Palmer, New Hyde Park, NY INTRODUCTION AND OBJECTIVE: Laparoscopic evaluation of the contralateral inguinal ring during inguinal hernia repair has allowed pediatric general and urologic surgeons to explore the contralateral side only in the presence of a patent processus vaginalis. The purpose of this study was to evaluate girls with inguinal hernias and determine if laparoscopic contralateral evaluation is warranted. METHODS: We performed a retrospective chart review of all females who underwent inguinal hernia repair between January 2003 and March 2008 in our pediatric urology practice. All patients underwent a standard inguinal approach for hernia repair. We evaluated the contralateral inguinal ring laparoscopically, through the ipsilateral hernia sac to determine the presence of a patent processus vaginalis. We determined the incidence of a contralateral inguinal hernia by age group. Patients who clinically presented with bilateral inguinal hernias or who did not undergo laparoscopic evaluation during hernia repair were also identified. RESULTS: A total of 50 female patients presented with an inguinal hernia. The mean age of patients was 4.8 years and ranged from 6 weeks to 12 ½ years. Twenty-eight of the hernias were right sided and twelve presented on the left side. Six patients presented clinically with bilateral inguinal hernias (4 of whom were under 2 years) and did not undergo contralateral laparoscopy. Three other patients, all less than 1 year of age did not undergo laparoscopy due to a fragile hernia sac. Forty patients with unilateral inguinal hernias underwent diagnostic laparoscopic evaluation of the contralateral inguinal ring. A patent processus vaginalis was identified in 7 girls (17.5%) and 33 girls (82.5% had normal contralateral anatomy (Table 1). There were no operative complications. CONCLUSIONS: Transinguinal diagnostic laparoscopic evaluation for a patent processus vaginalis is safe and effective for girls of all ages. Laparoscopic Results Stratified by Age Age (yrs) Unilateral Hernia Contralateral PPV <2 6/6 (100%) 0/6 (0%) 2-5 10/14 (71.4%) 4/14 (28.6%) >5 17/20 (85%) 3/20 (15%) Totals 82.5% 17.5% Source of Funding: None 486 PROXIMAL HYPOSPADIAS REPAIR WITH MINIMALLY MOBILIZED FLAPS; A NEW TECHNIQUE Ahmad A Al-Dessoukey*, Beni-sweif, Egypt; Hani Morsi, Mahmmoud Daw, Cairo, Egypt INTRODUCTION AND OBJECTIVE:To describe a new technique for the repair of proximal hypospadias with severe chordee when the plate is not appropriate for tubularization and review our results using this technique METHODS: Between January 2005 and October 2007 we performed Minimally Mobilized Flaps (MMF) repair in 21 patients having proximal hypospadias with severe chordee (Perineal hypospadias in 4 cases, scrotal in 6, and penoscrotal in 11). Age ranged from 5 months to 2 years (mean 11.5 months). Follow up ranged from 6 months to 18 months (mean 13 months). The technique can be summarized in these steps s5SHAPEDINCISIONCIRCUMSCRIBINGTHEURETHRALPLAT s3KINDEGLOVING s"ULBARDISSECTIONOFPROXIMALURETHRA s$IVISIONRESECTIONOFHYPOPLASTICPLATEDORSALPLICATION s 4HE PREPUCE IS SPLIT DORSALLY AND THE SKIN LEAmETS ARE transposed ventral to the shaft without unfurling, and the parallel medial edges are joined in midline. s )N EACH LEAmET ON BOTH SIDE AND PARALLEL TO THE MIDLINE longitudinal skin incision is mad (wide apart enough to be tubularized over appropriate sized catheter), thus creating a median plate. s4HESKINLATERALTOTHEINCISIONISMINIMALLYMOBILIZEDFROMTHE underlying dartos fascia. s4HE MEDIAN PLATE IS JOINED TO THE URETHRA AND THE GLANS AND tubularized over a catheter. s3ECONDLAYERCOVERAGEISDONEBYLOCALDARTOSTISSUEORTUNICA vaginalis flap. s3KINISCLOSEDINTHEMIDLINEANDCATHETERISLEFTFORDAYS RESULTS: Operative time ranged from 110-165 minutes (mean 137 min.) The cosmetic results were very good in all cases. None of the patients developed urethral stricture, meatal stenosis or weak urinary flow. A fistula developed in 1 patient (4.76%) Another patient had glans sutures disruption (4.76%), leading to meatal regression to become coronal. Another 2 cases developed sever postoperative wound infection leading to glans disruption and meatal regression to become coronal (9.5%). The overall complications rate, unrelated to infection was (9.5%). CONCLUSIONS: This new surgical technique for proximal hypospadias repair (MMF) is a simple one that offered very good cosmetic and functional results. The complication rate is acceptable and compares favorably with that of other techniques. Source of Funding: None