Pediatric Urology Case Reports

Number 4, 2020

88-93
Incomplete duplex renal system with severe obstruction at the uretero-ureteral junction and minor obstruction at the common stem-vesical junction: Challenging diagnosis and conclusive laparoscopic treatment

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

Abstract

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Number of views: 266

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.

94-97
Benign fibroepithelial polyps causing ureteropelvic junction obstruction in a child: A case report

Authors: SeyyedMohammad Ghahestani, Elaheh Shahab

Abstract

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Number of views: 271

The fibroepithelial polyps of the ureter are benign tumors derived from mesenchymal tissue, which can rarely cause obstruction of the ureteropelvic junction in children. Because the fibroepithelial ureteral polyps are difficult to accurately diagnose preoperatively, multiple diagnostic procedures are required for diagnosis. We report the case of a 5-year-old boy with intermittent gross hematuria, left flank pain and hydronephrosis diagnosed with fibroepithelial polyp by ultrasonography. We performed ureteroscopy to confirm the diagnosis and localize the polyp, which led us to surgical exploration and dismembered pyeloplasty due to the multiplicity and large size of the polyps. At the 18-month follow-up, the patient is recurrence-free.

98-101
Removal of proximally migrated double J ureteric stent through a percutaneous nephrostomy route in an infant

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

Abstract

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Number of views: 324

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.

102-106
Reflections on COVID-19 nasopharyngeal, fecal and peritoneal swabs in an infant with Wilms tumor: A case report

Authors: Alberto Mantovani, Giulia Bortot, Elisa Negri, Chiara Cini, Maria Chiara Cianci, Luca Landi, Lorenzo Masieri

Abstract

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Number of views: 259

Proximal Sars-Cov-2 pandemic had radically changed the way surgeons work in many departments, forcing to reserve surgical treatment only for emergency and oncologic cases. We report a case of a ten months-old girl with right-sided Wilms tumor and a previous diagnosis of Sars-Cov-2 infection, who underwent open right nephrectomy. Surgery was planned after negativization of five nasopharyngeal tests, despite the simultaneous positivity of two rectal swabs. The procedure was performed safely with appropriate personal protective equipment (PPE). To better investigate viral excretion, the anesthetist repeated nasopharyngeal swab under general anesthesia, which resulted positive. At the same time, two peritoneal swabs were collected and showed the absence of the virus in the peritoneal fluid. This case highlights the importance of combining swabs from various sources to increase sensibility of the test. The value of nasopharyngeal swab under general anesthesia should be reinforced as it can result positive even after many negative tests. Very little is known about transmission of the virus through the peritoneum as both presence and absence of Sars-Cov-2 have been reported in the peritoneal fluid. Upcoming literature will clarify which particular conditions determine viral penetration in this anatomical district.

107-111
Paratesticular spindle cell rhabdomyosarcoma: A case report of a rare tumor

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

Abstract

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Number of views: 267

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

112-115
Case report: Conservative treatment of renal laceration in a patient with von Willebrand's disease

Authors: Durwood Neal, Omar Hayek

Abstract

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Number of views: 243

We report a case of blunt renal trauma to a pediatric patient with von Willebrand's disease. The patient was successfully treated via conservative management. Currently, there is no specific guideline regarding the treatment of blunt renal trauma in pediatric patients with clotting disorders, but our case suggests that conservative treatment remains the gold standard.