JABOULAY/WINKELMAN PROCEDURE (HYDROCELECTOMY)
DESCRIPTION Hydrocelectomy is performed by incision of the hydrocele sac after complete mobilization of the hydrocele. Partial resection of the sac is then performed and the edges are sewn together behind the spermatic cord in the Jaboulay/Winkelman technique. Care is taken not to injure any spermatic cord contents.
REFERENCE
Ku JH, Kim ME, Lee NK, et al. The excisional, placation, and internal drainage techniques: A comparison of the results for idiopathic hydrocele. BJU Int. 2001;87(1):82–84.
JACK STONES
DESCRIPTION A term that refers to irregular, spiculated calcium oxalate stones, resembling children’s jacks, which are sometimes seen in the bladder.
REFERENCE
Dyer RB, Chen MY, Zagoria RJ. Classic Signs in Uroradiology. Radiographics. 2004;24:S247–S280.
JARISCH–HERXHEIMER REACTION
DESCRIPTION Originally observed by Jarisch in 1895 and later by Herxheimer and Kraus, this reaction occurs after patients are given mercury for the treatment of syphilis. The reaction is now associated with the antimicrobial treatment of spirochete infections such as leptospirosis, Lyme disease, tick-borne relapsing fever, and also syphilis. The reaction mostly occurs within 12–24 hr after treatment, and presents with symptoms such as rigors, malaise, headache, hypotension, and sweating. The reaction may be caused by a release of endotoxins or a transient elevation of cytokines, and it may be prevented with TNF-α antibodies or steroids.
REFERENCE
Pound MW, May DB. Proposed mechanisms and preventative options of Jarisch-Herxheimer reactions. J Clin Pharm Ther. 2005;30:291–295.
JEJUNAL–ILEAL BYPASS, UROLOGIC CONSIDERATIONS
DESCRIPTION Jejunal–ileal bypass is a form of bariatric surgery for treatment of morbid obesity. The complications following jejunal-ileal bypass center on a malabsorptive state and include mineral and electrolyte imbalances, protein malnutrition, enteric complications, and a list of other extra-intestinal manifestations (eg, arthritis, peripheral neuropathy, liver disease, etc.). Bariatric surgery has more recently developed newer techniques (eg, gastric sleeve, Roux-en-y bypass) which limit these complications and the jejunal-ileal bypass procedure has fallen out of favor. From a urologic perspective, bariatric bypass surgery can lead to a state of enteric hyperoxaluria and result in an increased risk of kidney stone formation. For patients with a prior history of nephrolithiasis, a 31.4% recurrence rate has been reported after bypass surgery. It is important for the urologist to establish appropriate prevention techniques and institute treatment when necessary for this high-risk group. (See also Section II: “Bariatric Surgery, Urologic Considerations.”)
REFERENCE
Whitson JM, Stackhouse GB, Stoller ML. Hyperoxaluria after modern bariatric surgery: case series and literature review. Int Urol Nephrol. 2010;42(2):369–374.
JEUNE SYNDROME (ASPHYXIATING THORACIC DYSPLASIA)
DESCRIPTION Jeune syndrome is a form of lethal, short-limbed dwarfism with features that include constriction of the upper thorax and polydactyly. It has autosomal recessive inheritance. Of urologic interest, renal dysplasia, sometimes leading to end stage renal disease (ESRD), is associated with the condition.
REFERENCE
Ring E, Zobel G, Ratschek M, et al. Retrospective diagnosis of Jeune’s syndrome in 2 patients with chronic renal failure. Child Nephrol Urol. 1990;10(2):88–91.
JOINT REPLACEMENT, UROLOGIC CONSIDERATIONS
DESCRIPTION Prophylaxis is no longer routinely indicated for patients receiving orthopedic pins, plates, and screws or even total joints. Antimicrobial prophylaxis is intended to reduce the risk of hematogenous joint infection in patients who fit the criteria for increased risk of total joint infection and who have an increased risk of bacteremia and who meet BOTH sets of criteria in the table here. For patients NOT meeting both these criteria, antimicrobial prophylaxis still may be indicated to reduce the risk of other infections. (Based on AUA Guidelines Best Practice Policy Statement on Urologic Surgery Antimicrobial Prophylaxis.)
TREATMENT
Recommended antimicrobial regimens:
• A single systemic level dose of a quinolone (eg, ciprofloxacin, 500 mg; levofloxacin, 500 mg; ofloxacin, 400 mg) PO 1–2 hr preoperatively.
• Ampicillin 2 g IV (or vancomycin 1 g IV over 1–2 hr in patients allergic to ampicillin) plus gentamicin 1.5 mg/kg IV 30–60 min preoperatively.
• For some procedures, additional or alternative agents may be considered for prophylaxis against specific organisms and/or other infections.
REFERENCE
Wolf JS Jr, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2007;179:1379–1390.
JUVENILE GANGRENOUS VASCULITIS, SCROTAL (PYODERMA GANGRENOSUM)
DESCRIPTION A variant of scrotal gangrene of unknown etiology, which is thought to be a variant of pyoderma gangrenosum. The lesions usually occur in healthy individuals <30 yo, following an upper respiratory infection. The lesions can present with scrotal itching or stinging, with ≥1 skin lesions. Lab findings can show an increased erythrocyte sedimentation rate (ESR) with normal microbiologic tests. Biopsy of the lesions reveals mostly neutrophilic dermal infiltrate and fibrinoid necrosis of small blood vessels without vasculitis. Treatment is systemic corticosteroids. The condition is often self-limited.
REFERENCE
Caputo R. Juvenile gangrenous vasculitis of the scrotum: Is it a variant of pyoderma gangrenosum? J Am Acad Dermatol. 2006;55(2 Suppl):S50–S53.
JUXTAGLOMERULAR CELL TUMOR, KIDNEY
DESCRIPTION Rare but important benign renal mass caused by the secretion of renin and generally affects adolescents and young adults. The ultimate cause is surgically curable hypertension. Patients (typically young females) present with severe diastolic hypertension, hypokalemia, and elevated plasma renin levels. CT, renal angiography, and renal vein sampling may be helpful in localization. The tumor is well circumscribed with fibrous capsule and the cut surface shows yellow or gray-tan color with frequent hemorrhage. The tumor is composed of monotonous polygonal cells with entrapped normal tubules. Immunohistochemically, tumor cells exhibit a positive reactivity for renin, vimentin, and CD34. Infrequent aggressive forms have been reported. Partial nephrectomy or enucleation is the treatment of choice.
REFERENCES
Dong D, Li H, Yan W, et al. The diagnosis and surgical management of juxtaglomerular cell tumor of the kidney. J Hypertens. 2010;28(3):628–632.
Kuroda N, Gotoda H, Ohe C, et al. Review of juxtaglomerular cell tumor with focus on pathobiological aspect. Diagn Pathol. 201126;6:80.