Pediatric Urology Case Reports

383-386

Authors: John Lazarus, Patrick Opoku Manu Maison, Justin Howlett

A 6 month old boy with normal external genitalia, presented with purulent urethral discharge from the neonatal period and recurrent urinary tract infections. Radiologic and urethrocystoscopic evaluation showed a midline structure connected to the prostatic urethra and discharging with pus. This structure, considered to be a prostatic utricle cyst was successfully drained endoscopically

391-394

Authors: Biserka Pigac, Silvija Mašić, Slavko Gašparov, Valentina Mašić

Ectopic adrenal tissue is usually found in kidney and retroperitoneum, yet other locations are considered uncommon. Spermatic cord remains one of the sites where this entity is mostly incidentally found during surgical procedure in childhood. Macroscopically, it represents as yellowish, lipomatous nodule. We present a case of ectopic adrenal tissue of spermatic cord in a 3- year- old boy, found during orchidopexy of the right testicle. Histopathological analysis of the spermatic cord nodule revealed adrenal cortical tissue composed of zona fasciculata cells. Although usually being benign and asymptomatic, cases of hyperplasia, adenoma and carcinoma arising from ectopic adrenal tissue have been reported. Therefore, removal of this tissue, when detected, is recommended.

399-404

Authors: Rahul Kumar Gupta, Beejal Sanghvi, Gayatri Munghate, Sonali Mane, Pooja Tiwari, Kedar Mudkhedkar, Sandesh V Parelkar

Ureteric diverticulum is a rare urological condition with only 47 cases described in the literature till 2013. A full term female infant presented with a huge cystic lump occupying almost the entire right side of the abdomen at 1 month of age. Ultrasonography and Magnetic Resonance Urography (MRU) revealed right sided gross hydronephrosis with pelvis appeared folded onto itself along with left sided mild hydronephrosis. On EC scan, differential function of right sided kidney was 0.9%. With working diagnosis of right sided giant hydronephrosis secondary to pelviureteric junction obstruction, the child was posted for Anderson - Hynes pyeloplasty through right flank incision. On exploration we were surprised to find ureteric diverticula. Excision of ureteric diverticulum with proximal ureterostomy was done. Distal part of ureter was transfixed. Histopathological examination of diverticulum showed presence of fibromuscular wall suggestive of true diverticulum. Since ureterostomy was draining only few drops of clear fluid and on repeat EC scan there was no improvement in function of right kidney, right nephroureterectomy was done after 6 months.

360-363

Authors: Jyoti Bothra, Charu Tiwari, Gursev Sandlas, Hemanshi Shah

Congenital anterior urethral valve is a rare condition causing significant obstructive uropathy in pediatric age group. It is much rarer than posterior urethral valve. However, the clinical course is similar. We present two cases of anterior urethral valves in children

369-372

Authors: Jayalaxmi S Aihole, Narendra Babu M, Dipanjan Haldar, Ravindra Sahadev

Most undescended testicles are asymptomatic and diagnosed in the first years of life. In some rare cases the diagnosis is established during childhood due to sudden torsion of the spermatic cord. Additionally, testicular torsion is a well-known urologic emergency that needs to be diagnosed and treated rapidly for the salvage of testis. We are here with reporting a case of torsion of an undescended testis with unusual clinical presentation, as acute abdomen, and its diagnostic dilemma and management.

378-382

Authors: Bruna Cecilia Neves De Carvalho, Carolina Talini, Leticia Alves Antunes, Maria Helena Camargo Peralta Del Valle, Ayrton Alves Aranha Junior, Antonio Carlos Moreira Amarante, Antonio Ernesto Da Silveira

Urethral duplication is a rare lower urinary tract anomaly, which can present with a variety of clinical manifestations. Here, we report four cases of urethral duplication and review the literature to report the diagnostic approach and treatments used for this condition. The cases demonstrated the variety of clinical symptoms and anatomy considerations of this particular malformation. Surgical treatment must be individualized according to the anatomical finds

337-340

Authors: Dayananda Sagar Gopal, Sunita Gopalan, Prakash Nayak, Anita Nagadi, Shyam Shankar, Sriram Patwari

Vesicovaginal reflux (VVR) is common in prepubertal females presenting with voiding dysfunction. However, VVR as a cause of gross hydrocolpos is uncommon in clinical practice. The varied clinical presentation and perplexing imaging findings often results in undergoing a battery of clinical and radiological tests before arriving at a definitive diagnosis. In this article we present the classical imaging features of non-obstructive hydrocolpos due to VVR which differentiates it obstructive causes that can present with similar imaging features.

346-349

Authors: Ada Molina Caballero, Alberto Pérez Martínez, Sara Hernández Martín

Ureteral stump syndrome is a medical condition caused by a refluxing distal ureteral remnant left after nephrectomy. Fungal colonization of the ureteral stump is uncommon and distant site infection is exceptional. We present a unique case of fungal peritonitis in a 13-year-old boy who had a right lower-moiety heminephro-ureterectomy at age three with a ureteral stump that served as reservoir for Candida resulting in the subsequent spontaneous fungal passage to the peritoneum.

356-359

Authors: Hulya Ozturk, Emine Dagistan, Fahri Yilmaz

Unilateral renal cystic disease (URCD) is a rare nonfamilial, nonprogressive disorder of one kidney and is not related with autosomal dominant polycystic kidney disease. The present case is a report of a 15-year-old female who had a huge multicystic mass involving the lower and middle part of the left kidney with normal minimal residual renal parenchyma at the upper pole. All the laboratory tests were within normal limits. The right kidney was entirely normal. Left nephrectomy was performed because of a significant morbidity. Here, the clinic, radiologic and pathologic findings are described and their differential diagnosis is discussed.

311-314

Authors: Virender Sekhon, Nitin J Peters, JK Mahajan

Penile hair tourniquet syndrome is a relatively uncommon clinical situation. It involves a thread of hair tied around a penis, causing strangulation which may result in various complications. It is seen mostly in circumcised boys from the developed nations. If not diagnosed early, it can lead to devastating sequelae and even loss of a vital organ. We report a case of penile hair tourniquet syndrome and a review of literature

320-324

Authors: Sayalee S Narwade, Ajit S Sawant, Ashwin S Tamhankar, Sunil R Patil, Kaushik R Patil

Cerebral palsy is the most common motor disability in childhood which result in huge socioeconomic costs. This children have a significant incidence of lower urinary tract symptoms. Clean intermittent self-catheterization is needed to avoid deterioration of renal function. But significant spasticity and resulting contractures of the adductors can interfere with the caretakers’ ability to provide perineal hygiene. Surgery in cerebral palsy affected child is challenging due to multiple associated comorbidities. The aim of this report is to describe quality of life and renal function for a mentally retarded child with cerebral palsy before and after Mitrofanoff diversion without bladder augmentation.

329-332

Authors: Carolina Talini, Letícia Alves Antunes, Bruna Cecília Neves de Carvalho, Jéssica Romanelli, André Luis Fortes Alves, Rafaela Galli, Karin Barszcz, Ricardo Possagno, Even Mol, Luís Fernando Garbuio, Ayrton Alves Aranha Junior

We report a 6 months-old male who presented a rare phenomenon of nonfused crossed renal ectopia associated with multicystic dysplasia. Male, prenatally diagnosed with cystic lesion in right hypocondria, presented as palpable mass in right upper abdominal quadrant at birth. Detailed radiologic evaluation including laparotomy confirmed a diagnosis of multicystic dysplasia in a crossed non-fused left ectopic kidney and leading to partial right ureteral obstruction, treated by surgical removal of the lesion.

275-288

Authors: Csaba P. Kovesdy, Susan Furth, Carmine Zoccali

Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for Chronic Kidney Disease. A high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic Kidney Disease in the long-term. The incidence of obesity-related glomerulopathy has increased tenfold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.

293-300

Authors: Victor Cavillon, Anne Schneider, Poornima Donepudi, Raphael Moog, Isabelle Lacreuse, Anne Sophie Weingertner, Romain Favre, François Becmeur

Prenatal diagnosis of an allantoic cyst with a patent urachus is rare. A urological etiology can sometimes be associated with it. We report 4 cases of allantoic cyst with a patent urachus and reviewed the literature to investigate for any etiology using the keywords “allantoic cyst” and “patent urachus”. Diagnosis of an allantoic cyst with a patent urachus was established during the first or second trimester of pregnancy. In two cases, rupture of prenatal cysts occurred and in one case, we described a prenatal vesicourethral abnormality. Surgery was performed with good results and no complications. A literature review collected 12 studies (15 fetuses) with a sex ratio of 3 boys/1 girl. The cysts ruptured in 2/3 of the cases, and in half of the cases, urinary abnormalities were found before birth (enlarged bladder, bladder prolapse). At birth, one boy had posterior urethral valve (PUV) and 4 boys had a bladder prolapse. The postoperative course was uneventful. We present our series with one case showing the etiology of a patent urachus during prenatal life. Cystoscopy seems to be valuable in the post-natal diagnosis. In the literature, we found one case of PUV. Surgery was performed with good results and no complications.

306-310

Authors: Kamal Nain Rattan, Jasbir Singh, Poonam Dalal, Deepika Jain

Primary renal teratomas are uncommon and preoperative diagnosis is difficult. Additional pathologies may be more difficult to diagnosis and may increase morbidity. We are reporting a case of large primary renal cystic teratoma which was presented with acute intestinal obstruction due to congenital band at ileum. Patient was successfully managed by dividing the congenital band and excision of teratoma in toto. Pathologic examination showed evidence for a primary renal mature teratoma. Serum alpha-fetoprotein is a reliable method of assessing recurrence.