Patricio Gargollo

430 statements · 3 topics · summaries given as host listed separately

Featured statements

we don't utilize the foreskin to do a reconstruction for mild hypospadius almost ever, if ever

quote · HIV

that's BXO until proven otherwise

quote · HIV

Epispadias (dorsal urethral defect) is extremely rare (<1/50,000) and represents the bladder exstrophy-epispadias spectrum with associated incontinence, pubic diastasis, and vesicoureteral reflux

clinical · Sarcoma (Ewing/Rhabdo)

Redundant foreskin appearance after circumcision is usually due to suprapubic fat pad displacing skin distally; if penis looks circumcised when fat pad is pushed down, no revision is needed

clinical · Sarcoma (Ewing/Rhabdo)

Office meatotomy can be performed with EMLA cream, straight hemostat crush of 6 o'clock web, and fine scissors; sutures at 3 and 6 o'clock have no proven benefit for reducing recurrence

clinical · Urinary Tract Infection

Balanitis xerotica obliterans (BXO) presents with white paper-like, scaly, hard skin at prepuce tip and does not respond to steroids; requires circumcision to prevent urethral stricture

clinical · Urinary Tract Infection

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Patricio's statements about HIV 151 statements

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Pediatric Urology Part I

Statement UTI risk in the first year of life is 3-4% overall, with uncircumcised boys having 1/100 risk vs circumcised boys 1/1000 risk Open

Statement Circumcision provides decreased risk for HIV, syphilis, gonococcus, HPV, and HSV-2, but not for chlamydia Open

Statement Kenya trial of ~3000 men showed 53% protection against HIV in circumcised cohort, trial stopped early due to significance Open

Statement Uganda trial of ~5000 males showed 50% of circumcised men became infected vs control group, also stopped early Open

Statement AAP policy states data are not sufficient to recommend routine neonatal circumcision, parents should receive accurate unbiased information Open

Statement Office circumcision cutoff: 3 months of age or less than 13 pounds (personal practice guideline, no data support) Open

Quotation if you're going to restrain the child any way either use a papoose board or anything else that when they get a little bigger it's going to be a little harder to do that Open

Statement Literature suggests exposing younger children to elective cases like circumcision under general anesthesia is not recommended from anesthetic safety standpoint Open

Quotation I personally feel that if you don't do them that there's really no reason to not refer that child to somebody who does do them Open

Statement Best analgesia method for circumcision is dorsal penile nerve block combined with ring block using 0.25% bupivacaine without epinephrine Open

Statement Plastibel device subjectively has more postoperative complications than Gomco or Mogan clamps Open

Statement Major injuries (glans amputation) from circumcision have been seen only with Mogan clamp use (2-3 cases observed) Open

Quotation the only time I've ever seen a major injury from a circumcision like Glands amputation has been when the Mogan clamp has been used Open

Statement Dorsal penile nerves run at 2 o'clock and 11 o'clock positions, block placed below pubic symphysis at ~1.5cm depth using 1cc/kg of 0.25% bupivacaine Open

Statement Mogan clamp glans amputation occurs when glans is pulled through the slit along with foreskin, especially with smaller glans Open

Statement Gomco bell sizes are 1.1, 1.3, 1.45, and 1.6 cm; 75% of time a 1.3 bell is used Open

Statement Mismatched Gomco bell and base can cause bell to pull up, exposing glans and causing injury during cutting Open

Statement Must take down preputial adhesions completely to see ridge under corona all around, or will leave asymmetric skin Open

Quotation you really want to force the skin off the bell rather than pull the bell off the skin Open

Statement Gomco bell should be left on for at least 5 minutes for older kids (near 3 months/13 lbs), 1-2 minutes for newborns Open

Statement Vaseline dissolves Dermabond, so parents must be instructed not to use Vaseline on Dermabond-dressed circumcisions Open

Statement For bleeding control, have 6-0 chromic or fast-absorbing plain suture and 1:1000 diluted epinephrine available in circumcision tray Open

Statement Fast-absorbing plain gut (6-0 or 5-0) leaves nicer cosmetic appearance than Vicryl for circumcision closure Open

Statement Physiologic adhesions (distinct line visible) do not need treatment and will lyse on their own as baby grows Open

Statement Lysing physiologic adhesions in office can turn a non-problem into a problem by creating raw surface and true bridges Open

Quotation you can turn a problem that's not a problem into a problem Open

Statement Skin bridges (no distinct line, two holes on each side) need treatment as they will not lyse and can tether penis with growth Open

Statement Most skin bridges can be treated in office with EMLA cream 30-40 minutes, hemostat clamp, and fine scissor division Open

Statement Redundant foreskin appearance often due to fat pad; if penis looks circumcised when fat pad pushed down, no intervention needed Open

Statement Have never seen an adolescent complain of too much foreskin; suspect most cases resolve with puberty and penile growth Open

Quotation I personally in my career have never seen an adolescent come in complaining of too much foreskin Open

Statement Perform 1-2 redo circumcisions per year in high-volume practice, suggesting most resolve spontaneously Open

Statement Meatal stenosis is exclusively seen in circumcised boys, caused by meatal rubbing against diaper/underwear creating inflammatory web at 6 o'clock Open

Statement Meatal stenosis requires intervention only when symptomatic: urine shoots straight up toward ceiling, child must sit to void Open

Quotation I've never seen an adolescent with meatal stenosis Open

Statement Have never seen an adolescent with meatal stenosis; many subjectively narrow meatuses become normal with growth Open

Statement Meatotomy can be done in office with EMLA cream, straight hemostat crush of 6 o'clock web, and fine scissor incision without sutures Open

Statement No data shows sutures at 3 and 6 o'clock reduce meatotomy recurrence rate compared to no sutures Open

Statement Micropenis clinical definition: stretched penile length >2.5 standard deviations below normal mean for age Open

Quotation don't be a hero with these things, you know, one of the highest areas of litigation are circumcisions that are done and then there's a problem afterwards Open

Statement Mean stretched penile length for 6-12 month old is about 4 cm (reference: Bin Abbas 1999) Open

Statement Buried penis looks like a short squat pyramid, not a structure coming out of the body Open

Quotation if it doesn't look quite right or quite like what you're used to just refer him to a pediatric neurologist, save yourself the hassle. It's just, it's not worth it Open

Statement Congenital megaprepuce occurs mostly in Hispanic patients and should not be circumcised due to risk of complete shaft skin loss Open

Statement Physiologic phimosis (soft, supple skin, no symptoms) does not require treatment regardless of age Open

Quotation even though the AAP has published guidelines as to when the foreskin should retract based on age, I don't really go on those Open

Statement Betamethasone 0.1% TID for 2-3 months results in >50% of children with phimosis having retractile foreskins Open

Quotation I honestly think that that dose is too low and that time period is too low to actually see an effect Open

Statement Lower betamethasone doses (0.05% BID for few weeks) are too low in dose and duration to see effect Open

Statement Secondary phimosis (hard stenotic ring after circumcision) responds to betamethasone 0.1% TID for 2-3 months in >50% of cases Open

Statement Balanitis xerotica obliterans (BXO) presents with paper-white, scaly, hard skin at prepuce tip and will not respond to steroids Open

Statement BXO can spread onto glans and into urethra causing significant urethral strictures; requires circumcision Open

Quotation that's BXO until proven otherwise Open

Statement Paraphimosis occurs when retracted foreskin is not brought back over glans, can become medical emergency with vascular compromise Open

Statement Paraphimosis treatment: pain control (EMLA or penile block), D50-soaked bandage wrap to reduce swelling, manual reduction Open

Statement Manual paraphimosis reduction: thumbs on glans, fingers on shaft skin, pinch shaft skin and push glans back into foreskin Open

Statement Manual reduction works 9 out of 10 times with good pain control and D50 swelling reduction; have never needed dorsal slit Open

Quotation I personally have never had to do a dorsal slit for a paraphymosis Open

Statement Main cause of penile trauma is zipper injuries; treatment is cutting zipper bridge with bolt cutter rather than manipulating zipper Open

Statement Second most common penile trauma is toilet seat crush injuries; conservative management if child voids without gross hematuria Open

Statement Gross hematuria after penile trauma requires urologist involvement for potential urethral injury evaluation Open

Statement Buck's fascia violation in penile trauma requires OR repair to prevent long-term scarring and potency issues Open

Statement Gross blood at meatus or gross hematuria after trauma requires full urinary tract evaluation and retrograde urethrogram before catheterization Open

Quotation please do not instrument that child because if there is a urethral injury, you can create a much bigger problem Open

Statement Hypospadias incidence is about 1 in 150 live births Open

Statement Hypospadias etiology is multifactorial; higher incidence in children conceived via in vitro fertilization Open

Quotation we don't utilize the foreskin to do a reconstruction for mild hypospadius almost ever, if ever Open

Statement Foreskin is not used for distal hypospadias reconstruction; can complete circumcision if found during procedure Open

Statement Undescended gonad with hypospadias requires full DSD workup; bilateral non-palpable gonads suggests congenital adrenal hyperplasia Open

Quotation undescended gonad. Hypospadius equals DSD workup Open

Statement Two palpable testicles with hypospadias means DSD risk is almost zero Open

Statement Hypospadias repair indications: cosmetic appearance and functional (ability to void standing, normal emission for fertility) Open

Statement Midshaft and distal hypospadias likely have no functional problems; repair is primarily cosmetic Open

Statement Controversy exists about repairing very mild hypospadias variants in young children given anesthesia exposure concerns Open

Statement Hypospadias repair involves urethroplasty (bringing meatus to tip) and phalloplasty (straightening curvature) Open

Statement Most chordee resolves after penile degloving; sometimes requires additional maneuvers for significant curvature Open

Statement Epispadias incidence is less than 1 in 50,000 live births, represents bladder exstrophy-epispadias spectrum Open

Statement Epispadias associated problems: urinary incontinence, pubic diastasis, vesicoureteral reflux Open

Statement True micropenis diagnosis requires objective measurement using age-specific stretched penile length tables Open

Statement Penile torsion repair not needed unless close to 90 degrees; foreskin not used in repair Open

Statement Penoscrotal webbing is obvious, not subtle; some surgeons use foreskin flaps for repair Open

Statement Labial adhesions incidence is about 2% in first two years of life, not seen in newborns (maternal estrogen protective) Open

Statement Labial adhesions require treatment only if symptomatic: post-void dribbling, skin breakdown, or recurrent UTIs Open

Statement Betamethasone ointment works well for labial adhesions; preferred over estrogen cream to avoid pubic hair development in toddlers Open

Statement Have performed formal lysis of labial adhesions in OR only once in career; most respond to topical treatment Open

Statement Imperforate hymen treatment is incision to open the hymen and drain retained vaginal secretions Open

Statement Prolapsed urethrocele is smooth, mucosa-covered, protrudes from urethra distinct from vagina, associated with prenatal hydronephrosis Open

Statement Paraurethral and perivaginal cysts (Gartner's duct, Skene's gland) present at birth, spontaneously regress with maternal estrogen loss Open

Statement Vaginal rhabdomyosarcoma appears as 'bunch of grapes' mass, not a single bulge Open

Urology Part I

Statement UTI risk in the first year of life is 3-4% overall, with uncircumcised boys having 1/100 risk versus circumcised boys 1/1000 risk Open

Statement Circumcision decreases risk of HIV, syphilis, gonococcus, HPV, and HSV-2, but does not change chlamydia risk Open

Statement Circumcision provides 53% protection against HIV transmission in randomized trials from Kenya and Uganda, with both trials stopped early due to significant benefit Open

Statement Office circumcision should be limited to infants 3 months or younger or weighing less than 13 pounds to minimize restraint difficulty and bleeding risk Open

Statement Exposing young children to elective general anesthesia such as for circumcision is not recommended from an anesthetic safety standpoint Open

Quotation I personally feel that if you don't do them that there's really no reason to not refer that child to somebody who does do them Open

Statement The best analgesia for circumcision is a dorsal penile nerve block combined with a ring block using 0.25% bupivacaine without epinephrine Open

Statement The Gomco clamp is preferred over Plastibell (subjectively more complications) and Mogen clamp (risk of glans amputation) Open

Statement Glans amputation during circumcision has been seen 2-3 times with Mogen clamp when small glans is pulled through the slit Open

Statement Complete preputial adhesion takedown is essential—you must see the ridge under the corona all the way around to avoid asymmetric skin removal Open

Statement When using Gomco, leave the bell on for at least 5 minutes for older infants (closer to 3 months/13 pounds) and 1-2 minutes for newborns Open

Statement When removing the Gomco bell, force the skin off the bell rather than pulling the bell off the skin to avoid separating crushed edges Open

Statement A safety pin through both edges of the dorsal slit helps pull foreskin through the Gomco base hole more easily Open

Statement Before clamping, check underneath the bell to ensure shaft skin (not scrotal skin) is visible and the median raphe is centered to avoid twisting Open

Statement Vaseline dissolves Dermabond, so parents must be instructed not to apply Vaseline after Dermabond circumcision Open

Statement Office circumcision tray should include 6-0 chromic or fast-absorbing plain suture for bleeding and 1:1000 epinephrine for topical hemostasis Open

Statement For OR circumcision, 6-0 or 5-0 fast-absorbing plain gut (used by plastic surgeons on face) heals nicely; Vicryl causes pie-crusting unless subcuticular Open

Statement Physiologic post-circumcision adhesions (distinct line visible, common in chubby babies) do not need treatment and will lyse spontaneously as the child grows Open

Statement Lysing physiologic adhesions in the office can turn a non-problem into a problem by creating a raw surface that forms a true skin bridge Open

Quotation you can turn a problem that's not a problem into a problem Open

Statement True skin bridges (no line, two holes on each side) require treatment because they tether the penis and do not resolve spontaneously Open

Statement Most skin bridges can be lysed in office with EMLA cream for 30-40 minutes, hemostat placement, and fine scissor division Open

Statement Redundant foreskin appearance after circumcision is usually due to suprapubic fat pad displacing skin distally; if penis looks circumcised when fat pad is pushed down, no revision is needed Open

Statement Dr. Gargollo has never seen an adolescent complain of too much foreskin after circumcision, suggesting most cases resolve with puberty Open

Statement Dr. Gargollo performs only 1-2 redo circumcisions per year despite high volume, indicating most redundant skin resolves spontaneously Open

Statement Meatal stenosis is a condition exclusively seen in circumcised boys, caused by meatal inflammation from rubbing against diaper/underwear creating a 6 o'clock web Open

Statement Meatal stenosis requires intervention only when urine stream deviates straight upward or child must sit to void, not for subjectively narrow meatus alone Open

Quotation I've never seen an adolescent with meatal stenosis Open

Statement Dr. Gargollo has never seen an adolescent with meatal stenosis, suggesting many subjectively narrow meatuses normalize with growth Open

Statement Office meatotomy can be performed with EMLA cream, straight hemostat crush of 6 o'clock web, and fine scissors; sutures at 3 and 6 o'clock have no proven benefit for reducing recurrence Open

Statement Micropenis is defined as stretched penile length greater than 2.5 standard deviations below the mean for age; mean is 4 cm at 6-12 months Open

Quotation don't be a hero with these things, you know, one of the highest areas of litigation are circumcisions that are done and then there's a problem afterwards Open

Statement Hypospadias, buried penis, penile-scrotal webbing, penile torsion, and congenital megaprepuce are contraindications to routine circumcision and should be referred to pediatric urology Open

Statement A buried penis appears as a short squat pyramid rather than a protruding structure; attempting circumcision can result in complete shaft skin loss requiring skin grafting Open

Statement Physiologic phimosis (soft, supple foreskin without symptoms) requires no treatment regardless of age, even in 5-8 year olds Open

Statement First-line treatment for symptomatic phimosis is betamethasone 0.1% three times daily for 2-3 months, with >50% success rate Open

Statement Secondary phimosis (post-circumcision cicatrix causing stenotic ring) responds to betamethasone 0.1% TID for 2-3 months in >50% of cases Open

Statement Balanitis xerotica obliterans (BXO) presents with white paper-like, scaly, hard skin at prepuce tip and does not respond to steroids; requires circumcision to prevent urethral stricture Open

Statement Paraphimosis management includes pain control, D50-soaked bandage wrap to reduce edema, and manual reduction with thumbs on glans pushing back through foreskin Open

Statement Dr. Gargollo has never had to perform a dorsal slit for paraphimosis, as manual reduction with proper pain control and D50 wrap is successful Open

Statement The main cause of penile trauma is zipper injuries; treatment is cutting the zipper bridge with bolt cutters rather than manipulating the zipper Open

Statement Toilet seat crush injuries to penis can be managed conservatively if child is voiding without gross hematuria; glands hematoma may look necrotic but resolves Open

Statement Buck's fascia violation in penile trauma requires OR repair to prevent long-term scarring and potency issues Open

Statement Gross blood at urethral meatus or gross hematuria after trauma mandates full urinary tract evaluation and retrograde urethrogram before catheterization Open

Statement Hypospadias incidence is approximately 1 in 150 live births, likely multifactorial etiology including in vitro fertilization exposure Open

Statement Hypospadias assessment requires evaluation of meatus location and degree of ventral curvature (chordee); more proximal meatus and greater curvature indicate more complex repair Open

Statement For distal hypospadias discovered during circumcision, the circumcision can be completed because foreskin is not used in modern distal hypospadias repairs Open

Quotation finish the circumcision, you know, don't leave the skin kind of hanging there, just get it done Open

Statement Non-palpable gonad with hypospadias requires full disorder of sexual differentiation (DSD) workup; bilateral non-palpable gonads suggests congenital adrenal hyperplasia Open

Quotation undescended gonad, hypospadius equals DSD workup Open

Statement Very mild hypospadias variants (megameatus, distal) raise controversy about timing of repair given anesthesia exposure concerns in young children Open

Statement Hypospadias repair involves urethroplasty (tubularizing urethra with second-layer coverage) and phalloplasty (straightening chordee, often resolved by degloving alone) Open

Statement Epispadias (dorsal urethral defect) is extremely rare (<1/50,000) and represents the bladder exstrophy-epispadias spectrum with associated incontinence, pubic diastasis, and vesicoureteral reflux Open

Statement Penile torsion (twisted median raphe) requires surgical correction only if rotation is ≥90 degrees Open

Statement Labial adhesions occur in approximately 2% of girls in the first 2 years of life, not in newborns due to protective maternal estrogen Open

Statement Labial adhesions require treatment only for symptoms: post-void dribbling, skin breakdown, or recurrent UTIs; asymptomatic adhesions should not be treated Open

Statement First-line treatment for symptomatic labial adhesions is betamethasone ointment BID for 6 weeks, preferred over estrogen cream to avoid pubic hair development in prepubertal girls Open

Statement Surgical lysis of labial adhesions is rarely needed; Dr. Gargollo has performed it only once in his career Open

Statement Differential diagnosis for midline genital bulge includes imperforate hymen, prolapsed urethrocele, paraurethral/perivaginal cysts, and vaginal rhabdomyosarcoma Open

Statement Prolapsed urethrocele is distinct from vagina on exam, associated with prenatal hydronephrosis, and requires renal bladder ultrasound and VCUG Open

Statement Paraurethral and perivaginal cysts (Gardner's duct, Skene's gland) present at birth, spontaneously regress with loss of maternal estrogen, and show patent urethra and vagina on exam Open

Statement Vaginal rhabdomyosarcoma appears as a 'bunch of grapes' mass rather than a single bulge and requires oncology involvement Open

Patricio's statements about Sarcoma (Ewing/Rhabdo) 128 statements

Open the Sarcoma (Ewing/Rhabdo) collection →

Urology Part I

Statement UTI risk in the first year of life is 3-4% overall, with uncircumcised boys having 1/100 risk versus circumcised boys 1/1000 risk Open

Statement Circumcision decreases risk of HIV, syphilis, gonococcus, HPV, and HSV-2, but does not change chlamydia risk Open

Statement Circumcision provides 53% protection against HIV transmission in randomized trials from Kenya and Uganda, with both trials stopped early due to significant benefit Open

Statement The AAP states that data are not sufficient to recommend routine neonatal circumcision, and parents should be given accurate, unbiased information Open

Quotation these data are not sufficient to recommend routine neonatal circumcision Open

Quotation parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision Open