Pediatric Urology Case Reports

146-150

Authors: Adelais K. Tzortzopoulou, Panagiota Giamarellou, Aikaterini Michail-Strangia, Alexander Passalides

Lymphatic filariasis is very rare in Greece, despite her geographical position. Only a few cases about affected young men and children have been published during the last century. We report a 2-year-old Caucasian boy presented to our emergency department with a painless swelling in the right scrotum during the last 10 days. Neither fever nor discomfort was reported. In the clinical examination, the right scrotum was hard but painless. An ultrasound and a computed tomography (CT) scan showed a mass (d 2.04 x 1.34x 2.48 cm) in the right epididymis and it was thought to be a solid tumor of epididymis. A decision of an exploratory scrotal surgery was made and a right orchiectomy was performed. The histological examination showed that here were a lot of eosinophil, lymphocytes and some parasites, namely Wuchereria bancrofti in the parenchyma of both testis and epididymis. Then some more specific blood tests were done, which were negative for filariasis, and it was decided that chemotherapy was not needed. In a follow-up period of one and two years after the surgery, all the tests (blood tests and CT scan) were normal and the child had a normal everyday life. Sometimes some clinical cases in children could be tricky. In Europe, such parasitic diseases, as filariasis, are very rare and their diagnosis is difficult for even an experienced pediatric surgeon

156-160

Authors: Marianna Iaquinto, Emilio Vittorio Merlini, Barbara Tadini, Giovanni Palazzo, Antonio Fonzone Caccese, Roberto De Castro

A ureteric loss is a devastating event and can be corrected with intrinsic urinary tissue using different surgical techniques such as direct anastomosis, psoas hitch, Boari flap, transuretero-ureterostomy and renal autotransplantation. We report a case of successful left ureter total substitution with appendix after failed ureteral reimplantation and acute renal failure, in an infant affected by high grade vesicoureteral reflux in a left functionally solitary kidney.

165-170

Authors: Soner Coban, Ali Riza Turkoglu, Muhammet Guzelsoy, Murat Ozturk, Osman Akyuz, Efe Onen, Kadir Acibucu, Salim Zengin

Nowadays laparoscopy has been used for diagnostic purposes; also it has become more preferable to place intra-abdominal testes to the scrotum than to open surgical method. In the management of nonpalpable testes, laparoscopy is a standard and widely accepted technique. The high success rates in diagnosis and treatment, as well as cosmetic results and short hospitalization periods provided by laparoscopy are the other advantages of this technique. In this case report, we shared a case of nonpalpable testes treated by laparoscopic method.

122-126

Authors: Serpil Sancar, Esra Ozcakir, Arzu Sizgen, Mete Kaya

Cystic lesions of adrenal gland are rare and usually asymptomatic in children. Cysts usually have been found incidentally by imaging studies during an investigation of other abdominal causes. Differential diagnosis of adrenal cysts from other cystic disease may not be possible by imaging studies. Although the management of adrenal cysts is a controversial subject, surgical treatment is still important for both diagnosis and treatment. In this case report, we will discuss the surgical approach of a case with adrenal cyst detected incidentally.

131-135

Authors: Sharon Lo, Julia Han, Andrew Rabley, John Shields, Vincent Bird

Bladder calculi are rare in children; they are typically associated with congenital abnormalities of the bladder, foreign bodies, intestinal mucosa, or infection. There is a high risk of bladder calculi with bladder exstrophy, a rare congenital condition. Primary bladder closure is usually performed in the first days of life, but subsequent bladder calculi are associated with about 15% of bladder exstrophy repairs. We report a case of hair-bearing epithelium serving as a nidus for intravesical stone formation in a 24-year-old male who underwent exstrophy repair as an infant. Our case emphasizes need for close and continued follow-up in patients who receive bladder exstrophy repair as infants. This is the first report in the literature of hair-bearing epithelium serving as the nidus for bladder stones in this unique patient population.

141-145

Authors: Hulya Ozturk, Mervan Bektas, Ozgur Mehmet Yis

Ureterocele is the dilatation of the submucosal ureter as a result of a defect in the Chwalla membrane absorption. The many types and clinical presentations of ureters present a significant challenge to clinicians. Although stone formation in the ureterocele is common in adults, it is much less common in pediatric patients. Here, we present a case report of a two-year-old boy with single-system ureteroceles containing multiple small stones.

99-103

Authors: Umesh Bahadur Singh, Shrikesh Singh, Tanvir Roshan Khan

A wide spectrum of renal, ureteral, and urethral abnormalities has been reported in a patient born with Prune belly syndrome (PBS). The obstruction in the urinary tract can be found anywhere from uppermost (pelviureteral junction) to lowermost (prostatic membranous urethra) urinary tract. The mesenchymal developmental arrest is the main embryological factor responsible for the major features of the syndrome like urethral abnormalities or gastrointestinal abnormalities. PBS patients with urethral obstruction commonly had a patent urachus, because of which such patients survived, early death usually occurred in those patients who did not had a patent urachus. We are reporting an interesting case of prune belly syndrome with superior vesical fissure (an exstrophy variant). To the best of our knowledge this was first reported case of association of two congenital anomalies having common embryological defect process. Presence of superior vesical fissure gives a new insight about the benefits gained by the child for surviving with such fatal congenital anomalies.

108-111

Authors: Metin Gorgu, Ali Gokkaya, Ali Dogan, Jehat Kizilkan, Ertugrul Karanfil

Here, we present a case of hypospadias and median raphe deviation with literature review. A 4-yearold patient presented with subcoronal hypospadias and treated by using tubularized incised plate urethroplasty technique. Additionally, a longitudinal dorsal dartos flap was harvested and transposed to the ventral side by the buttonhole maneuver. The ventral view of the patient penis showed a 15 degree deviation to the right side of the center.

118-121

Authors: Stefania Lasorella, Alberto Verrotti, Luca Zagaroli, Maria Laura Iezzi

Henoch–Schönlein purpura (HSP), also known as immunoglobulin A (IgA) vasculitis, is a systemic vasculitis of unknown cause, mostly affecting children, in which complexes of IgA and components of complement are deposited on arterioles, capillaries, and venules. It is characterized by nonthrombocytopenic palpable purpura, abdominal pain, and arthritis. While renal involvement is well-known and frequent, scrotal involvement is uncommon and, therefore, not easy to be interpreted. Here, we report a case of a 3-year-old boy hospitalized for HSP, presenting with bilateral acute scrotum, and discuss diagnosis and treatment.

69-72

Authors: Sudhir Singh, Jiledar Rawat

Hair tourniquet syndrome is characterized by circumferential strangulation of an appendages or genitalia by human hairs or fibres. Here we are reporting a rare case and its successful management of coronal urethrocutaneous fistula developed due to penile hair tourniquet syndrome (PHTS) in a 5 years old child

77-79

Authors: Omer Faruk Yagli, Ali Gokkaya

Testicular torsion is one of the most common causes of acute scrotum in children and adolescents. The bell-clapper deformity, which detected in 12% of males, is the most important reason that leads to testicular torsion. In our case, a 14 years old male admitted to our clinic due to testicular torsion developed after ejaculation with manual sexual stimulation of the penis. The most important criteria in determining the loss of testis is the degree and duration of torsion. Here, we discussed the rare cause of testicular torsion along with diagnostic and therapeutic characteristics.

84-88

Authors: Julian O. Galvis-Angulo, Sandra Milena Rueda-Quijano, Natalie Estefania Pinto-Briceño, Angie Lucía Méndez-Zaraza, Bernardo Santamaría-Fuerte, Armando J. Lorenzo, Victor H. Figueroa

Uretero-appendicular fistulas represents a rare entity, closely related to appendicitis and are usually encountered intraoperatively. A literature review showed six published cases –only one of them involving a pediatric patient. We describe the case of a ten year-old girl with history of recurrent urinary tract infections (UTIs) since the age of three. Following a six-year asymptomatic period, she was referred for evaluation after a new diagnosis of UTI complicated by a right distal ureteral stone. The patient underwent ureteroscopy and laser stone fragmentation. During the endoscopic procedure a mature, well-epithelialized ureteral tract to the peritoneal cavity was encountered. The procedure was converted to open exploration through a right Gibson incision, where an appendicular phlegmon associated with an uretero-appendicular fistula with passing of faecoliths to the ureteral lumen was found. An appendectomy was performed along with primary fistula closure. Uretero-appendicular fistulas represent a rare entity. Our case highlights the relation between this type of fistula with appendicitis, its unexpected intraoperative diagnosis and the unusual presentation, as the patient did not present clinical findings compatible with acute abdomen.

94-98

Authors: Gursev Sandlas, Bhushanrao Bhagawan Jadhav

Bladder exstrophy is a rare developmental anomaly. Four principle variants of bladder exstrophy have been described and they themselves are rarer than the bladder exstrophy. Authors describe the management of a case of pseudoexstrophy type of variant in a 9 month old male child with penile duplication with torsion and coronal hypospadias. The rectal fascial defect was repaired without osteotomy as the distance between two pubic bones was <4 cm (3.1 cm). Genital reconstruction with excision of duplicate atrophic penile shaft and repair of coronal hypospadias with detorsion of the functional penile shaft could be accomplished. The patient had good outcome in terms of cosmesis and urinary stream. Total of 18 cases of the pseudoexstrophy have been described till date. Pseudoexstrophy of bladder is a very rare condition and can simultaneously present with other defects like omphalocele, anorectal malformations, pouch colon, multiple or solitary urogenital anomalies. The principles of correction though remain same with correction of abdominal wall defect with or without osteotomy depending upon severity of pubic diastasis. Other anomalies can undergo treatment as per standard protocol.

28-46

Authors: Giorgina B Piccoli, Mona Alrukhaimi, Zhi-Hong Liu, Elena Zakharova, Adeera Levin

Chronic Kidney Disease affects approximately 10% of the world’s adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women’s Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women’s health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world’s population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.

52-54

Authors: Apoorva Kulkarni, Vishesh Dikshit, Abhay Gupta, Geeta Kekre, Paras Kothari

A 4-year-old girl was admitted with the complaint of pain in lower abdomen and dysuria. She had exstrophy repair at 6th month of life. Radiographic investigations revealed a large bladder calculus. An innovative treatment in the form of laser lithotripsy was carried out to prevent damaging an already highly compromised urinary bladder with an open surgery.

59-63

Authors: Angeline Rojas Díaz, Juan David Iregui Parra, Lina Huérfano, Ana Ortiz Zableh, Jaime Pérez Niño

Testicular tumors of the adrenogenital syndrome (TTAGS) are a rare disease, with a benign curse. We present the case of a 12-year-old patient with congenital adrenal hyperplasia (CAH), precocious puberty and bilateral testicular masses. Hormonal control had been adequate. Incidental finding of bilateral testicular masses, with negative testicular tumoral biomarkers. The patient underwent right testicular sparing surgery, finding an intraparenchymal nodular mass. Pathological study showed a TTAGS, positive for CD99, Melan A, inhibin and synaptophysin markers. Conservative management was decided.