Pediatric Urology Case Reports

70-73

Authors: Ahmed Ibrahim Balah, Ahmad Beltagy, Mohammed Youssef, Waleed Dawood

We reported a case of donkey bite to the external genitalia of a 10 years old child. We had performed delayed reconstruction of the penis following adequate saline washing and wound debridement; under antibiotic coverage. Previous studies have shown that delayed repair together with strict wound management resulted in satisfactory outcomes in most victims of such animal bites.

79-82

Authors: Loganathan Arun Kumar, Jujju Jacob Kurian

Ureteral atresia is a rare congenital anomaly and is usually associated with renal dysplasia. Distal atresia is more common and other associated urinary anomalies are rare. We report a case of an eight year old boy who presented with left flank pain and vomiting. Ultrasound abdomen and pelvis and renal scintigraphy were suggestive of hydroureteronephrosis with obstructed drainage. He was suspected to have ureteric stricture and taken up for surgery. Cystoscopy and retrograde pyelogram revealed an incomplete duplication with lower moiety ureter ending blindly. Exploration of left renal fossa showed a duplex anomaly with normal upper moiety and hydronephrosis of lower moiety with a ureteric stump. Ureteropelvic anastomosis was done between the dilated renal pelvis and the blind ending ureter. Patient was doing well post operatively with good function in both moieties. Review of literature shows only two previously reported cases of proximal ureteric atresia. Preservation of renal function in an older child has also been reported only once. Ureteral atresia is usually diagnosed intra-operatively and various reconstruction options are available in patients with preserved function.

88-94

Authors: Rajendran Ramaswamy, Rayan Ahmed Baz, Marwan Alchami, Ghazi Mukattash

Absence of any orifice in perineum, presence of smooth perineum, and absence external genitalia are characteristic of cloacal dysgenesis sequence (CDS). Newborn of 40w gestational age, born to mother with oligohydramnios, had very low APGAR scores, and was put on ventilator. Child had dysmorphic facies, short neck, compressed chest, no urinary bladder swelling, absence of any perineal orifice, a raised fold of skin at the site of phallus and bilateral talipes calcaneovalgus. Esophageal atresia (EA) was diagnosed clinically and radiographically. Pulmonary hypoplasia, distal tracheoesophageal fistula (TOF), thin, flat and broad cervical vertebrae with spina bifida, partial sacral agenesis and cardiac anomalies were demonstrated by radiographs and echocardiography respectively. Child progressively more desaturated on ventilator and died at 16h after birth before detailed assessment including sex could be done. CDS results from failure of urorectal septum to fuse with cloacal membrane at 7th week of intrauterine life. It can occur in male and female. CDS is lethal resultant from associated severe pulmonary hypoplasia and renal insufficiency. Very rarely such child is born alive as in our case. Association of CDS with EA+TOF is extremely rare. In view of 5 long-term survival reports of CDS, prenatal diagnosis is warranted and treatment should be initiated.

51-54

Authors: Hamdi Ozcan, Canan Ceran

Behçet’s disease (BD) is a rare systemic inflammatory disorder of the blood vessels and tissues. It is rarely seen in children. The clinical course of the disease in children is similar to that of the adults by symptoms such as recurrent oral ulcers, genital ulcers and ocular inflammation. Additionally, urological manifestations rarely seen in BD. Here we present two children with BD and epididymoorchitis confusing with testicular torsion. Since BD is rarely observed in children, it is very difficult to diagnose the patients with epididymo-orchitis. Treatment for the testicular torsion is immediate surgical therapy to prevent the testicular necrosis. On the other hand epididymo-orchitis caused by BD should be treated medically. Unnecessary surgery on BD patient can affect morbidity negatively. We aimed to take attention to this rare condition to prevent the patients from unnecessary operation.

59-61

Authors: Tiffany Perkins, Dennis Peppas, Eran Rosenberg

Children are more likely to be exposed to blunt trauma-induced kidney damage due to the lack of perirenal adipose tissue, weakness in the abdominal muscles, and less ossified thoracic cage. Grade 5 renal injury may be an indication for urgent surgical intervention. Here, we describe a case of pediatric blunt trauma with initial computerized tomography (CT) scan demonstrating complete renal devascularization suggestive of grade 5 renal injury. However, subsequent imaging demonstrated normal vascularization of the kidney. Renal artery spasm was likely the cause for the initial CT findings, which mimicked a grade 5 renal injury.

65-69

Authors: Mehmet Mazhar Utangac, Serdar Gundogdu, Bilge Turedi, Mehmet Ogur Yilmaz, Mehmet Emin Balkan, Nizamettin Kilic

Presence of multiple calculi in a single system ureterocele is a rare condition. A 3-year-old boy presented with recurrent urinary tract infections in whom multiple calculi were noted in the urinary bladder on x-ray and ultrasound scan. In addition, ultrasound showed the presence of ureterocele in the size of 18x15x12 mm. Open surgery revealed an ureterocele with multiple stones. Here, we present a boy with multiple stones in the left ureterocele diagnosed intra-operatively due to its rarity, etiology and treatment options.

21-32

Authors: Deidra C. Crews, Aminu K. Bello and Gamal Saadi; for the World Kidney Day Steering Committee

Kidney disease is a global public health problem, affecting over 750 million persons worldwide. In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management.

38-41

Authors: Tunc Ozdemir, Ali Sayan, Ahmet Arikan

We herein report two patients who underwent Leadbetter-Politano ureterocystoneostomy whose ureters were passed through sigmoid colon during operation. Presentations and treatment strategies of these patients were discussed.

46-49

Authors: Erika Llorens de Knecht, Santiago Guadarrama Vega, Claudia Quintian Schwieters, Anna Bujons Tur

Thrombosis of an extraspermatic blood vessel has been reported to be an unusual cause of acute scrotum. We describe the case of a 7-year-old boy who presented with an acute painful left scrotal swelling. Imaging demonstrated a heterogeneous left scrotal mass, which was surgically resected. The anatomopathologic study revealed a thrombosed vascular structure. Three months later, another extraspermatic venous thrombosis occurred and was also resected. A complete thrombophilia study was done. A G20210A prothrombin gene heterozygous mutation was identified as the cause of the thrombotic event. A venous thrombosis should be considered as a possible cause of acute scrotum in European Caucasian patients, due to its increased prevalence. We reviewed the G20210A prothrombin gene mutation, which is associated with thrombosis.

1-4

Authors: Erol Basuguy, Salih Bayram

Urethral duplication is a rare congenital malformation with multiple clinical manifestations. Here, we present a case involving a boy with hypospadiac urethral duplication and multiple congenital anomalies. The patient had additional anomalies including a posterior urethral valve, left vesicoureteral reflux and right renal agenesis. This case is discussed in terms of the type of urethral duplication and the importance of additional anomalies

8-12

Authors: Prabudh Goel, Minu Bajpai

Most male infants are born with a foreskin that does not retract then and this is normal; glanularpreputial adhesions are physiologic and universal. Separation of these adhesions is a continuously evolving process which happens gradually and spontaneously. However, inability to retract the prepuce or preputial ballooning may be a cause of significantly anxiety amongst the newly blessed parents. The situation in rural population is further compounded by the culture of ‘oiling’ the glans inherited ancestrally if not transmitted genetically. Herein, the authors submit to medical literature an unusual complication of preputial adhesiolysis –development of bridging glanular- preputial adhesions. The clinical and social aspects are discussed. A description of the procedure of adhesiolysis along with an insight into the embryology and relevant literature was considered indispensable.

17-20

Authors: Ugur Uyeturk

Children exposed to air gun pellets may also have a different clinical picture, from mild tissue damage to life-threatening injury. Although these weapons are known as toys, there has been a significant increase in the muzzle velocity of these weapons with advances in gas technology, recently. Air gun injuries are frequently presented in head, neck and thorax region, but injuries in genitourinary tract are rare in children. Here, we report a 12-year-old boy who was injured by a random shot with an air gun, due to the features of his diagnosis and treatment.

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.