Pediatric Urology Case Reports

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.

1-6

Authors: Kalpana Kumari, Priyanka Naranje, Tripti Nakra, Seema Kaushal, Diya Roy, Saket Davera, Sandeep Agarwala, Ahitagni Biswas, Venkateswaran K. Iyer, Amit Kumar Dinda

Wilms tumor (WT) is the most common childhood tumor of the kidney, which histologically mimics various stages of nephrogenesis. Spectrum of chemotherapy induced histopathological changes has been described in literature, and is one of the most important predictors of disease outcome and survival rates. Extensive chondroid differentiation and absence of necrosis in a post-chemotherapy nephrectomy specimen of a radiologically proven Wilms tumor is an unusual finding. Herein, we present the case of 6-year-old girl from South Africa who received a 10-week course of chemotherapy upon radiological diagnosis of WT, and post-surgery nephrectomy specimen revealed extensive mature cartilage island formation on histology raising diagnostic dilemma. Reporting of such cases is extremely important to recognize tumor morphological heterogeneity, particularly post- chemotherapy, and developing consensus for selecting further treatment and clinical follow-up.

14-17

Authors: Volkan Sarper Erikci, Merve Dilara Oney, Gokhan Koyluoglu

Epidermoid inclusion cysts (EIC) is a disease caused by the nidation of the epidermal tissues and sebaceous materials into the dermal and subcutaneous layers. This entity is usually observed after trauma and surgical procedures. A 5-year-old boy with a ventral penile mass was admitted to our department. The history of the patient revealed that he was operated at the age of 1 year for hypospadias in a different medical center. The patient’s history also revealed that during the initial operation, a skin graft was used for covering urethroplasty. One year later the operation, a ventral penile mass was observed by his mother during wash. The mass continued to increase in size reaching of 1 cm in diameter. The mass was excised and the histopathological study revealed that the mass was compatible with an EIC. With 2 years of follow up the patient is disease free. EICs after penile surgical interventions may be a factor of anxiety for both the children and their parents. In order to avoid this unwanted complication, implantation of the superficial tissue layers into the deep the dermal and subcutaneous tissues should be avoided.

23-25

Authors: Md. Samiul Hasan, Ipsita Biswas, Umama Huq

We describe a case of posterior urethral valve 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 reduce the pressure on the bladder. On the other hand, incomplete valve ablation may contribute to the recurrence of the fistula.

119-122

Authors: Vini Joseph, Suraj Gandhi, Syamantak Basu, Neha Sisodiya Shenoy, Hemanshi Shah

We present a rare case of exstrophy variant - inferior vesical fistula. A two-year-old boy with normal continence presented with a suprapubic pit and mucosal plate on the penile dorsum. Examination and cystoscopy revealed vesical fistula. The fistula was closed and the penis was reconstructed. Recognition of the exstrophy variant is important because the treatment and prognosis are very different.

127-131

Authors: Volkan Sarper Erikci, Ali Sayan, Gokhan Koyluoglu

Hair tourniquet syndrome (HTS) is a rare condition and may pose diagnostic dilemma. The purpose of this study is to report our experience in 3 female cases with HTS involving genitalia. All the patients in this series presented with swollen and edematous genitalia and clitoris accompanied by strangulation in clitoris or labia minora with a hair thread. Strangulating hair was excised and removed under local anesthesia. The pain was cleared away and edematous discoloration disappeared immediately. Local application of antibiotic ointment was added to the treatment in these cases for a period of 6-7 days. The anatomy of the genitalia was found to be normal in these children during the follow up exam. A brief literature review on this subject is also given in this review.

137-140

Authors: Cristiana Maximiano, Albina Silva, Jorge Correia-Pinto, Angélica Osório

The acute scrotum is usually due to testicular pathology, but, less often, it could be related to abdominal or retroperitoneal conditions, such as adrenal hemorrhage. The adrenal hemorrhage in the newborn is a rare condition with prevalence of 0.2%. We present a case report of an adrenal hemorrhage in a full-term neonate. The conservative management was performed, with periodic clinical and radiological follow-up. There was a favorable outcome with complete resolution of hematoma at 12 weeks. Within this unusual case, the authors want to emphasize the fact that in presence of acute scrotum it is imperative to exclude testicular torsion. The Doppler ultrasonography is a valuable resource but it should be allied with minicious physical examination. The conservative management is recommended in the majority of the cases of adrenal hemorrhage, avoiding unnecessary exploration.

95-99

Authors: Ruankha Bilommi

Malignant peripheral nerve sheath tumors (MPNST) are rare, aggressive soft tissue sarcomas arising from peripheral nerves that present great challenges to known treatment modalities. Here, we present a case of MPNST involving the dorsum of a penis in a 13-month-old boy. The mass was incomplete excised and a circumcision was performed. Histological study revealed spindle cell tumor of the lesion. Immunohistochemistry showed a strong positive staining for tumor cells. A high grade malignant peripheral nerve sheath tumor was diagnosed.

106-110

Authors: Agnese Roberti, Francesco Turrà, Maria Esposito, Anna Maria Cotrufo, Federica Marinoni, Giovanni Di Iorio

In 1986, Fowler and colleagues described a condition currently known as Fowler's syndrome in young women with unexplained urinary retention associated with polycystic ovary syndrome. Herein, we present a case of a 13-year-old woman diagnosed with Fowler's Syndrome as a result of clinical, radiological and urodynamic electromyogram (EMG) findings. Fowler's syndrome should be considered in the differential diagnosis in children with unexplained chronic urinary retention.

114-118

Authors: Yasar Issi, Sedat Simsik, Unal Bicakci

A four-year-old boy presenting with neuropathic bladder and hydrocephalus developed Fournier’s gangrene of the scrotum and perineum. At first, he was in septic shock and intubated. After debridement and grafting, he was taken to the normal service room from the intensive care unit. He was discharged on the 29th postoperative day. We performed bilateral orchiectomy due to testicular involvement and also repair and flap application to urethra due to its involvement. We think that our case is interesting because Fournier’s gangrene is already rare in children and our case also contains atypical involvement sites such as testes and urethra.