Pediatric Urology Case Reports

28-36

Authors: Julie R Ingelfinger, Kamyar Kalantar-Zadeh, Franz Schaefer

World Kidney Day 2016 focuses on kidney disease in childhood and the antecedents of adult kidney disease that can begin in earliest childhood. Chronic kidney disease (CKD) in childhood differs from that in adults, as the largest diagnostic group among children includes congenital anomalies and inherited disorders, with glomerulopathies and kidney disease in the setting of diabetes being relatively uncommon. In addition, many children with acute kidney injury will ultimately develop sequelae that may lead to hypertension and CKD in later childhood or in adult life. Children born early or who are small-for date newborns have relatively increased risk for the development of CKD later in life. Persons with a high-risk birth and early childhood history should be watched closely in order to help detect early signs of kidney disease in time to provide effective prevention or treatment. Successful therapy is feasible for advanced CKD in childhood; there is evidence that children fare better than adults, if they receive kidney replacement therapy including dialysis and transplantation, while only a minority of children may require this ultimate intervention Because there are disparities in access to care, effort is needed so that those children with kidney disease, wherever they live, may be treated effectively, irrespective of their geographic or economic circumstances. Our hope is that World Kidney Day will inform the general public, policy makers and caregivers about the needs and possibilities surrounding kidney disease in childhood.

42-45

Authors: Ryuta Watanabe, Takeshi Sugahara, Hitoshi Hamada

We report a case of the complete separation of the testis and epididymis in an undescended testis, which is a very rare phenomenon. It is a situation associated with an undescended testis and appears to be one of the cases of fusion abnormalities. In all reported cases, vas deferens andepididymis or the vas deferens alone were located more distally than the undescended testis. In our case, histological examination of the left vas-epididymis complex showed rete testis-like tubular tissue which has a risk for malignant transformation. Long-term observation is essential.

52-55

Authors: Alev Suzen, Nazile Erturk, Ozgur Ilhan Celik

Fibroepithelial polyp of vagina (FEPV) is a mucosal polypoid lesion with a fibro vascular stalk and oedematous or hypocellular stroma covered by squamous epithelial surface. FEPV is extremely rare before menarche and after menopause. This article describes a two year old girl with a vaginal polyp and the histological analysis of which revealed to be a FEPV. Surgical excision of the mass was performed, and in 1 year of follow-up no recurrence was detected. A review of the literature showed that there were four cases of FEPV in neonatal girls. While these reported cases were neonatal, our case is the first case of FEPV in a two year old girl.

1-6

Authors: Rajendran Ramaswamy, Govinda Ravi, Rayan Baz A, Ghazi Mukattash I, Saif Saeed

Congenital giant megaureter presents as abdominal mass and impose diagnostic difficulties. It can be associated with other upper urinary tract anomalies. A female newborn with antenatal diagnosis of polycystic kidneys was admitted at birth due to lower abdominal mass. Ultrasound and CT scans diagnosed a multiloculated cystic lesion in the mid and lower abdomen along with right side multicystic kidney. At laparotomy, an extaperitoneal, lobulated cystic swelling was found due to rightside giant megaureter. Its lower end was of normal caliber and orthotopic. End cutaneous ureterostomy was done. Intravenous urogram and isotope renograms showed nonfunctioning right kidney. She also had grade II vesicoureteral reflux on left side. Child suffered urinary infection twice. At 9m age, right nephroureterectomy was done. Histopathologic examination was consistent with cystic renal dysplasia and dilated ureter. This is the first case report of giant megaureter associated with ipsilateral multicystic dysplastic kidney in newborn.

12-16

Authors: Jyoti Bothra, Gursev Sandlas, Shalika Jayaswal, Hemanshi Shah

Urinary extravastion after blunt abdominal trauma is seen often and generally treated conservatively. However a blunt renal trauma causing huge amount of extravasations and symptoms disproportionate to the severity of trauma should alarm the surgeon towards an underlying occult renal pathology usually an obstruction. In this case series, we share three such experiences and their management

23-27

Authors: Paula Nunes1, Nidia Rolim, Renato Mota

Ureteropelvic junction (UPJ) obstruction poses a diagnostic challenge when the patient arrives at the emergency department with severe recurrent back pain without previous record of this condition. Extrinsic factors including crossing vessels or intrinsic factors such as adynamic segment of proximal ureter can cause UPJ obstruction. We report a case of a 16 year-old female patient with ureteropelvic junction syndrome occurring at adolescence, caused by two accessory vessels. She was submitted to a laparoscopic dismembered pyeloplasty with favorable outcome.

1-8

Authors: Irom Keshorjit Singh

Fournier’s gangrene is an uncommon form of necrotizing fasciitis in children. It needs prompt diagnosis and treatment to avoid the high morbidity and mortality. In the present study we are reporting a 3 months old infant with Fournier’s gangrene predisposed by diaper rash due to poor hygiene. The infant was treated by debridement and primary repair with a good outcome

15-19

Authors: Bahattin Aydogdu, Mehmet Hanifi Okur, Hikmet Zeytun, Selcuk Otcu

A megameatus with intact prepuce (MIP) is an unusual variant of an anterior hypospadias that accounts for 3% of hypospadias repairs. It is characterized by a widely splayed coronal or subcoronal meatus, a deep glanular groove, a normally conformed prepuce, and no chordee. In this case, good cosmetic and functional outcomes, such as achievement of a straight urine stream and patient satisfaction, were achieved using the tubularized incised plate (TIP) procedure. However, each case of MIP is unique, and a suitable procedure should be tailored to individual cases.

27-32

Authors: Ankur Arya, Vikash Kumar, Prakash Pawar, Ashwin Tamhankar

Urinary ascites from bladder perforation in neonate is a rare event reported to occur more commonly following umbilical artery catheterization. Other causes include bladder perforations in neonates with bladder abnormalities, following bladder instrumentation or idiopathic bladder perforations. The present manuscript describes a full-term female neonate with spontaneous bladder perforation who was successfully managed with early operative intervention. We also present a review of the current literature and also discuss the pathogenesis, diagnosis and management of this rare entity.

1-4

Authors: Cansu Unden Ozcan, Teoman Ozcan, Banu Yaman, Selcuk Yazici

Hemangiomas are the most common tumor of infantile period and usually involved sites are head and neck (%50), followed by trunk and extremities. Hemangioma is rarely described in genitals. We report a 17-months-old patient with a hemangioma of the preputium penis. The tumor was completely removed surgically and histological examination revealed an infantile hemangioma.

10-15

Authors: Suleyman Cakmakci, Necmettin Penbegul, Mehmet Mazhar Utangac, Mansur Daggulli, Onur Dede, Mehmet Nuri Bodakci, Ahmet Ali Sancaktutar, Yasar Bozkurt

Bladder tumours are rare in children, with only 0.4% of cases occurring in the first 2 decades of life. Herein, a pediatric patient who underwent TUR-B with a holmium: yttrium-aluminum-garnet (Ho:YAG) laser is presented. Its histopathology was reported as urothelial papilloma.

23-28

Authors: Mete Kaya, Serpil Sancar, Esra Ozcakir

Isolated epispadias is rare congenital anomaly. An uncommon variation of this anomaly may present with intact prepuce, and it may not be recognized until later during childhood. Herein, we aim to report a case of isolated epispadias with intact prepuce who underwent modified Cantwell-Ransley repair because of rarity.

1-6

Authors: Ryan W. Tubre, Nathan Locke, Alexander Kats, Eugene Lee, J. Patrick Murphy

Ganglioneuromas originate from neural crest sympathogonia of the autonomic nervous system. These tumors are benign, fully differentiated tumors that contain mature Schwann cells, ganglion cells, fibrous tissue and nerve fibers. Ganglioneuromas commonly localize in the abdominal and mediastinum regions, such as the adrenal gland, paraspinal retroperitoneum and posterior mediastinum. However, these tumors are rarely localized to the urinary bladder and, herein, we present a brief review of the literature and a ganglioneuroma of a 16-year-old female patient as the second case reported in the urinary bladder.

13-16

Authors: Arzu Akdag, Sule Arici, Betul Orhaner, Anil Dogan

Prune belly syndrome is a rare congenital disorder defined by a characteristic clinical triad: Abdominal muscle deficiency, severe urinary tract abnormalities, and bilateral cryptorchidism. We describe a preterm neonate of Prune Belly syndrome who had abdominal muscle deficiency, multicystic dysplastic kidney, urethral hypoplasia and pulmonary hypoplasia. We presented this rare case with the data gathered from the literatüre.

25-30

Authors: Jaime Pérez, Cristina Domínguez

Describe the scrotal surgical approach for abdominoscrotal hydrocele (ASH) with preservation of testicular function with midterm follow-up. Two patients diagnosed with ASH and contralateral testicular abnormalities. Both had scrotal correction for ASH, one had contralateral testicular neonatal torsion and the other contralateral communicating hydrocele. Four-year follow-up no complications or recurrence, and normal Anti-Mullerian hormone level. This pathology is a clinical diagnosis and it is treated with surgery via a scrotal approach, preventing sequels, contralateral complications and preservation of testicular function.