Pediatric Urology Case Reports

147-152

Authors: Ilse Van Horebeek, Michel Wyndaele, Piet Verlinde, Dieter Ost, Abraham Cherian, Gunter De Win, Dominique Trouet

We present a ten-year-old boy with episodic left flank pain, vomiting and microscopic hematuria. Imaging showed hydronephrosis characteristic for ureteropelvic junction (UPJ) obstruction. Pyeloplasty revealed a ureteral polyp, histopathologic examination confirmed the diagnosis of a fibroepithelial polyp. Fibroepithelial polyps of the ureter are a rare cause of UPJ obstruction in children. The most common presentation is episodic flank pain and/or hematuria. Imaging can be guiding, but pre-operative diagnosis is difficult. After surgical resection recurrence is rare.

158-163

Authors: Letícia Alves Antunes, Carolina Talini, Bruna Cecilia Neves de Carvalho, Naiane Mayer, Sabrina Tristão Longo, Antônio Carlos Moreira Amarante

Genitourinary tuberculosis is rare in children. The aim of this study is to describe an unusual case of renal tuberculosis in a 16 years old girl, diagnosed with Hinman Syndrome and chronic renal failure. During a hematuria investigation the cystourethrogram revealed grade V right vesicoureteral reflux and small bladder. Ultrasonography demonstrated various cysts in left kidney with irregular content, suggesting dysplastic multicystic kidney. Scintigraphy showed functional exclusion of the left kidney. Total laparoscopic nephrectomy was proposed. Gregoir right ureteral reimplantation and Mitrofanoff mechanism using the distal left ureter were also indicated. During surgery presence of multiple cysts in the left kidney with caseous aspect, left ureter obstruction with caseous content in the lumen and bladder mucosa with friable and thickened wall were found. Histopathological study revealed chronic necrotizing granulomatous inflammation. Mantoux tuberculin skin test was strongly reactive, and family history was positive for pulmonary tuberculosis 10 years earlier. This paper shows the importance of bringing extrapulmonary tuberculosis to the roll of differential diagnosis of hematuria. Early treatment is important to avoid disease progression with functional loss of the organs as happened in this case.

170-175

Authors: Secil Conkar, Ipek Kaplan Bulut, Sevgi Mir

Renal abscess is uncommon in childhood. The common manifestations include fever, lumbar pain, abdominal pain and occasional flank mass. Renal ultrasonography enables us to achieve an early diagnosis, however; it may still be insufficient to distinguish it from pyelonephritis. Renal abscesses are usually associated with different predisposing conditions. In the present report, we aim to describe a case of a previously healthy child who developed a renal abscess. Keywords

181-187

Authors: Carolina Talini, Letícia Alves Antunes, Bruna Cecília Neves de Carvalho, Douglas Fagundes Teixeira, Michael Malca Sepúlveda, Murilo da Silva Padilha, Maria Helena Camargo Peralta del Valle

Xanthogranulomatous pyelonephritis (XGPN) is a rare and severe variation of chronic pyelonephritis characterized by suppurative destruction of renal parenchyma and its substitution with chronic inflammatory infiltrate. Male, 8 years old, admitted to the pediatric urology service at 7 years of age, with bladder and renal lithiasis. First symptoms started when he was 2 years old but presented no relapse until he turned 7 years old. During two years he had recurrence of renal lithiasis and underwent multiple surgical procedures. He remained asymptomatic for a short period of time and when presented fever and urinary symptoms again and underwent CT scanning that demonstrated left kidney enlargement associated with calculi and air bubbles in its interior, suggesting xanthogranulomatous pyelonephritis. Uretherostomy was performed and the patient had good clinical improvement. Renal exclusion was documented through scintigraphy and total left nephrectomy was performed, with a large amount of pus drained. Histopathology confirmed XGPN diagnosis. One year after surgery, there has been no recurrent renal lithiasis or urinary tract infection. Despite being a rare condition in children, XGPN has great importance as it can be often confused with pediatric renal tumours. Early diagnosis is important in order to promote better survival and clinical outcomes.

193-198

Authors: Prashant S Patil, Gupta Abhaya, Kothari Paras L, Kekre Geeta, Dikshit Vishesh K, Shahaji Deshmukh, Apoorva Kulkarni

Nutcracker syndrome is caused by a compression of the left renal vein between the aorta and the superior mesenteric artery. It results in left renal venous hypertension, and the subsequent development of venous varicosities of the renal pelvis, ureter, and gonadal vein. We report a rare case in an 8-year-old boy who presented with a history of intermittent episodes of hematuria leading to anemia and left flank pain. Ultrasound examination of abdomen revealed bulky left kidney and features of subacute medical renal disease. Computed tomography of abdomen showed compressed left renal vein between aorta and superior mesenteric artery. Authors report the successful operative management of this rare syndrome in a pediatric patient.