Pediatric Urology Case Reports

139-142

Authors: Padmapriya Balakrishnan , Thirunavukkarasu Arun Babu , Vijayan Sharmila

Cystic partially differentiated nephroblastoma (CPDN) is among the rare kidney tumors of childhood. Here, a case of CPDN in a baby who was operated with the diagnosis of multicystic kidney is reported. Clinical and imaging studies have a limited role in the differential diagnosis and diagnosis of this entity. A careful histopathological study is required to distinguish between CPDN and other types of multicystic kidneys. Because of the rare potential for aggressive behavior of this tumor, nephrectomy is the treatment of choice alone.

149-154

Authors: Erin Choi , Erin K. Barr , Viviane Mamlok , Cynthia Smith , Matthew Timberlake

Venous tumor thrombus is a known manifestation of Wilms’ tumors in a minority of cases but has not been previously described in association with cystic nephroma. We report an original case of a histologically-benign cystic nephroma presenting with venous tumor thrombus extending to the inferior vena cava. The tumor thrombus was not detected by preoperative Doppler ultrasound. The patient was successfully treated with radical nephrectomy, tumor thrombectomy, and IVC closure. Postoperatively, the patient underwent genetic testing which revealed a DICER1 mutation—known to predispose affected individuals to a variety of benign and malignant tumors—and requires intensive surveillance for associated conditions.

159-163

Authors: Syamantak Basu, Apoorva Makan, Akriti Tulsian, Suraj Gandhi, Neha Sisodiya Shenoy, Hemanshi Shah

Ureteral anomalies are difficult to diagnose on routine investigations in the background of a megaureter. Ureteric valves are a rare cause of congenital obstructive uropathy. Mid ureteric valves are rarer than proximal or distal ureteric valves, and most patients are misdiagnosed preoperatively. Therefore, intraoperative identification is critical. We present a case of mid ureteric valve which presented as unilateral hydroureteronephrosis.

116-120

Authors: Paarth Kapadia, Shreeya Popat, Angela G. Mittal

Hydrocolpos is a rare congenital genitourinary anomaly that can cause clinically significant urinary tract obstruction with oligohydramnios and hydronephrosis antenatally and renal failure postnatally. Here, we discuss the management of a neonate with hydrocolpos and renal failure. Vaginostomy tube and bladder catheterization have been described previously. However, in this population, external tubes can be difficult to manage and have a high propensity of failure. Therefore, the patient was managed via creation of a vaginostomy, which allowed for continuous passive drainage of fluid into a diaper and maintained a decompressed urinary tract until further reconstruction could be pursued.

126-130

Authors: William J. Scott, Aaron J. Shaw, Kenice D. Ferguson-Paul

Perinephric abscess is an uncommon infection in children, but it is usually caused by Escherichia coli, Staphylococcus aureus, Proteus mirabilis and Pseudomonas aeruginosa. Group B Streptococcus (GBS) is an uncommon cause of perinephric abscess or serious bacterial infections beyond the neonatal period. Comorbid conditions such as diabetes mellitus and immunosuppression can increase the risk of GBS invasive disease. We describe a 10-year-old female who presented with 1-month of right-sided flank pain and swelling with ultrasound showing large (>3 cm) right perinephric and subcutaneous abscesses. She was additionally diagnosed with new onset type 2 diabetes mellitus (DM) during admission. Abscess cultures obtained after placement of two percutaneous drains and the initiation of broad-spectrum intravenous antibiotics grew beta-hemolytic GBS. Here, we present to our knowledge, the first known documented case of GBS perinephric abscess in a school-aged child with DM. Much of the knowledge of perinephric abscess management is extrapolated from adults, therefore making optimal treatment in the pediatric population challenging. We propose that GBS be considered in the etiology of perinephric abscess in children with DM and other immunosuppressing conditions. In addition, percutaneous drainage of larger abscesses (>3 cm) in conjunction with antibiotic therapy is a reasonable management strategy.

136-139

Authors: Sevinc Akdeniz, Ulas Alabalik, Mehmet Hanifi Okur

We report the case of a 16-year-old female with a huge mass (40 × 30 × 40 cm) on the left ovary, causing mild bilateral hydronephrosis. Ultrasonography and computed tomography allowed us to diagnose this condition and showed an associated uretero-hydronephrosis. A unilateral salpingooophorectomy was performed on the left ovary, and final pathology revealed a mature cystic teratoma. The patient did not experience any problems in the follow-up six months later, and her hydronephrotic appearance disappeared.

88-93

Authors: Marianna Iaquinto, Roberto De Castro, Maria-Grazia Scarpa, Alessia Cerrina, Daniela Codrich, Edoardo Guida, Federica Pederiva, Maria Antonietta Lembo, Flora Maria Murru, Jürgen Schleef

Twin obstructive megaureters associated with duplex renal system is a rare malformation, particularly when a giant ureter dilation is present. We report an original case, initially misinterpreted, of a right incomplete duplex renal system with huge disproportion between the upper pole giant megaureter and the lower pole moderate megaureter, with severe obstruction at the uretero-ureteral junction and minor obstruction at the uretero-vesical junction. Uro-magnetic resonance imaging allowed conclusive diagnosis and the laparoscopic approach was effective for definitive, successful treatment.

98-101

Authors: Nirmalya Ray, Ujjwal Gorsi, Tejeshwar Singh Jugpal, Ravi Prakash Kanojia, Manavjit Singh Sandhu

Proximal migration of double J-stent (DJ stent) can be a reason for failure of its cystoscopic removal. Antegrade percutaneous nephrostomic removal of the stent can be done in such cases. Although the technique is described in adults and older children, the technique requires some modification when used in infants because of smaller calibre of pelvicalyceal system. Here we describe a case of a 6 month old male child who was treated by robotic assisted pyeloplasty for left sided ureteropelvic junction obstruction followed by placement of DJ stent. Cystoscopic removal of the stent 6 weeks after surgery was not possible due to proximal migration of the stent. Hence, antegrade percutaneous nephrostomic removal of the stent was performed using micro-snare. Certain novel technical modifications, like advancement of a diagnostic angiographic catheter in pelvicalyceal system, has been used in this case to reduce the risk of urothelial injury. Thus, antegrade removal of DJ stent with few technical modifications can be used safely in infants for removal of proximally migrated stents.

107-111

Authors: Han Kun Ng, Shankaran Thevarajah, Ann Feng Pan

Spindle cell rhabdomyosarcoma (RMS) is a rare variant of embryonal rhabdomyosarcoma. This tumor commonly involves paratesticular region of young males. Herein we report a case report of right paratesticular spindle cell rhabdomyosarcoma in a 16-year-old boy, who was referred to us for painless right scrotal mass. Staging computerized tomography (CT) showed no nodal or distant metastasis. The right radical inguinal orchidectomy was performed. Diagnosis of paratesticular spindle cell rhabdomyosarcoma was confirmed by histopathological and immunohistochemical examination. Paratesticular spindle cell RMS is a rare tumor and morphologically it may mimic other spindle cell neoplasms. Immunohistochemistry plays a pivotal role in its diagnosis. Making a correct diagnosis is crucial owing to the different treatment modalities available for this tumor

60-66

Authors: Aleix Soler-Garcia, Sonia Pérez Bartólez, Vanessa Arias Constantí, Núria Elvira Sanz Marcos

Defects of the urachus obliteration may lead to urachal abnormalities such an urachal cyst, which tend to rest asymptomatic. We report a case of a four-old-year boy who referred a three-week history of abdominal pain, dysuria and fever. A hypogastric mass was observed at the exploration. The ultrasonography and the computed tomography were compatible with an infected urachal cyst. Intravenous antibiotic therapy was started, with an optimal response. Four months later, a chirurgical complete excision of the urachal cyst was performed. Among different congenital disorders of the urachus, urachal cysts and patent urachi are the most frequent. Urachal cysts may become infected, causing suprapubic pain, dysuria, fever and abdominal mass, as well as signs of peritonism. The main tool for diagnose these lesions is ultrasonography. They could potentially degenerate into adenocarcinoma in adults, which is rare but associated to bad prognosis. Urachal remnants have been classically managed surgically. However, an active surveillance of these lesions with a conservative treatment could be an alternative, since spontaneous resolution is more common than previously thought.

71-75

Authors: Rahul K Gupta, Soundharya S, Beejal V Sanghvi, Kedar P Mudkhedkar, Rujuta S Shah, Deepa P Makhija, Satej S Mhaskar, Kamal Kant Khidtta, Sandesh V Parelkar

Urinary incontinence in a child secondary to a severe congenital anatomical disorder or due to complication of a previous surgery can be difficult to manage. Decisions can be especially hard when a redo procedure is being considered. We present one such case where a 6 year old girl previously operated for cloaca was brought with incontinence and after much consideration of options available, underwent a modified ureterosigmoidostomy to aid in her continence. The modification used was detubularized isolated ureterosigmoidostomy, described by Atta et al in 1996.

82-87

Authors: Bilge Turedi, Isik Senkaya Signak, Mehmet Ugur Yilmaz, Fatih Celik, Mehmet Mazhar Utangac, Mehmet Emin Balkan, Nizamettin Kilic

Patients with nutcracker syndrome (NCS) associated left varicocele are at high risk of varicocele recurrence when treated only with routine surgical approach for varicocele. An eleven year-old boy who had mild symptoms for NCS and left grade 3 varicocele referred to our clinic. To cure varicocele and to decrease left renal vein pressure, an end to end anastomosis was performed between left spermatic vein and inferior epigastric vein after inguinal microscopic varicocelectomy. His six months follow-up was uneventful. In this case report, we present that this method in children with NCS is a safe and effective method.

26-40

Authors: Philip Kam-Tao Li, Guillermo Garcia-Garcia, Siu-Fai Lui, Sharon Andreoli, Winston WingShing Fung, Anne Hradsky, Latha Kumaraswami, Vassilios Liakopoulos, Ziyoda Rakhimova, Gamal Saadi, Luisa Strani, Ifeoma Ulasi, and Kamyar Kalantar-Zadeh, for the World Kidney Day Steering Committee

The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. Aggravatingly, CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. Crucially, however, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions – be it primary, secondary or tertiary. This complementing article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for noncommunicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management and treatment are often lacking. Hence, there is an urgent need to increase the awareness of the importance of preventive measures throughout populations, professionals and policy makers.

45-51

Authors: Shyamendra Pratap Sharma, Sarita Chowdhary, Arjdeo Upadhyay, Manoj Kumar Yadav, Shiv Prasad Sharma

The case in this study was presented, the features in the diagnosis and treatment of rare complications such as bladder stone and vesicorectal fistula caused by the injection needle, which is a foreign body in the bladder. A 1-year-old male child came to our outpatient department with chief complaints of straining during micturition, dribbling of urine and history of high-grade fever, chills & rigor. A kidney, ureter, and bladder (KUB) X-ray revealed an approximately 1.5 cm bladder stone with radiopaque linear foreign body. On diagnostic cystoscopy anterior, posterior urethra was normal, fecal debris, stone and a needle was seen coming out through posterior wall of bladder. Open anterior cystolithotomy was done to remove 1.5-cm stone and a foreign body described as injection needle 24 gauge surrounded with fecal debris coming out through posterior wall was also removed. Fistulous tract was present and probed with 5 Fr feeding tube. A diversion colostomy was done. Patient discharged with colostomy and in follow up after 1 month micturating cystourethrogram (MCU) and distal loopogram of colon were normal; no fistulous communication present. Colostomy was closed after 3 months. There has been many cases reported in literature about insertion of different foreign bodies in bladder but foreign body ( injection needle) leading to bladder stone and vesicorectal fistula is first of its kind as far as our knowledge is concerned.

56-59

Authors: Esra Ozcakir, Sefer Tolga Okay, Ipek Guney Varal, Mete Kaya

A case of posterior urethral valve is described with multiple urethroperineal fistulas. This association is extremely rare. The crucial point in the diagnosis is to distinguish these fistulas from the urethral duplications that actually guide the treatment. The presence of these fistulas in patients with posterior urethral valve may have a beneficial effect on renal function as it reduces the pressure on the bladder. On the other hand, incomplete valve ablation may contribute to the recurrence of the fistula.