Testicular cavernous hemangioma presenting as an ipsilateral lesion in a child with multicystic dysplastic kidney

Childhood malignant testicle tumors are very rare. In the literature to date, it has been reported that there are only 24 cavernous hemangioma cases existing in English literature. In this study, we discuss a testicular mass case which was diagnosed as cavernous hemangioma. The patient, who followed for left multicystic dysplastic kidney since his birth, was admitted to our clinic with complaints of left testicular mass and pain at 1-year of age. Histopathological investigation revealed cavernous hemagioma. Even if it has its characteristic ultrasonographic findings, radiology is too far beyond to eliminate the malignancy, final diagnosis can only be made after orchiectomy.

Sclerotherapy of a Symptomatic Renal Cyst

Simple renal cysts are not commonly found in children. They occur in a small percentage of cases, with an incidence of 0.2%-0.5%. These cysts are typically solitary and develop in the renal cortex. Pain, infection, hematuria, hypertension, or obstruction of the collecting system are indications for treatment. When intervention is necessary, there are several ways to reduce cyst volume. In this report, we discuss the pediatric case of a solitary giant renal cyst and its therapeutic approach. We present a symptomatic pediatric renal cyst patient treated with a sclerosing agent. A simple renal cyst is a rare condition in children, and its treatment includes conservative management, percutaneous sclerosing agent injection, and surgical approach. Choosing the appropriate treatment according to the patient's condition and clinical symptoms is essential. We think that sclerotherapy should be the first-line therapy before surgery in symptomatic simple renal cysts.

Continuous-type splenogonadal fusion: report of a rare case

Splenogonadal fusion is a rare congenital anomaly. It has two subtypes, discontinuous and continuous. Up to one-third of continuous-type fusion is associated with other congenital anomalies. We present a continuous-type splenogonadal fusion case that was found incidentally during indirect hernia repair; the testicle was preserved during excision. Laparoscopic exploration was helpful in identifying the isolated polysplenia as the origin of continuous-type splenogonadal fusion, and in excising the cord-like attachment proximally. The patient had no other associated anomaly.

A rare clinical finding of posterior urethral valve: Recurrent epididymo-orchitis

Recurrent epididymo-orchitis is a rare condition in children. Considering that obstructive infravesical pathologies, such as posterior urethral valves, may cause recurring epididymo-orchitis in children, a thorough examination of the genito-urinary system will prove essential for the diagnosis and treatment of the main pathology. We herein present a case of posterior urethral valve presenting with recurrent episodes of epididymo-orchitis.

Clinical features and long-term outcomes of idiopathic urethrorrhagia

The aim of this study was to describe the clinical features and long-term outcome of the patients who were treated at our institution for idiopathic urethrorrhagia. The data of 10 male patients, who underwent cystoscopy between October 2010 and March 2013 due to urethrorrhagia, were evaluated retrospectively. Ten male patients aged between 8 and 16 years at first submission. Four patients (40%) had low voiding frequency (2-3 per day). Three of the four patients had abnormal uroflowmetry/EMG findings. Cystoscopy was done in all patients which revealed bulbar urethral inflammation and hemorrhage in all. Symptoms were not resolved on three of the patients who were under observation, having symptoms on average for 29.6±10.5 months. Complete resolution developed in the other seven patients. Six of the patients` symptoms were resolved soon after cystoscopy. In the patients' with or without normal uroflowmetry/EMG findings urethrorrhagia resolution rates were 86% and 33%, respectively. In the evaluation of urethrorrhagia; detailed history taking, basic laboratory investigation and cystoscopy are enough. The typical patients may be treated expectantly. In our opinion, it seems that dysfunctional voiding and infrequent voiding might cause delayed remission and/or recurrence of urethrorrhagia. Even though, it does not effect the treatment, in the persistent cases, confirmation of diagnosis by cystoscopy helps to lessen the anxiety of the family and might decrease the use of many unnecessary diagnostic tools in the long term follow ups.

Pyosalpinx and hydrosalpinx in virginal adolescents: report of two cases

Pyosalpinx and hydrosalpinx are conditions mainly seen in adult women, but also among sexually active adolescents and can bring added hazard to fertility. However these conditions are very rare in childhood, as well as in adolescent girls who are not sexually active. We are presenting two rare cases of young girls in early puberty with hydrosalpinx and pyosalpinx. Both girls had a history of abdomino-pelvic surgery in childhood for congenital bowel anomalies and fecal incontinence. Such cases are good reminders that girls with known abdomino-pelvic anomalies and surgical procedures in childhood need long term follow-up, in particular when entering puberty and maturation. The two cases show how fallopian tubes can be indirectly affected and present in adolescence with serious problems needing surgical procedures and potentially threatening future reproductive system performances.

The EXIT for Prenatally Diagnosed Cervical Cystic Teratoma: A Case Report

The Ex-utero intrapartum treatment (EXIT) is a procedure performed during caesarean section while on fetal-placental circulation. We present a prenatally diagnosed cervical cystic mass causing tracheal compression which was managed successfully with the EXIT procedure.

Diagnostic value of hydrodistention of the ureteral orifice

INTRODUCTION/OBJECTIVE

The dynamic hydrodistention (HD) classification is a basic and objective way of rating the ureteral orifice opening. This study evaluated the value of hydrodistention of the ureteral orifice in the diagnosis of vesicoureteral reflux (VUR).

MATERIAL AND METHODS

Between January 2012 and March 2013 the HD grade in 106 ureters was prospectively assigned. A 9.5-Fr rigid cystoscope with a 0-degree lens was used in all procedures. Warm saline was used and the irrigation bag was placed approximately 1 m above the bladder level on full flow. The grading is as follows: H0 denotes absence of ureteral dilation; H1 indicates dilation of the ureteral orifice only; H2 allows visualization of the intramural ureter; and H3 allows visualization of the extramural ureter. Indications for cystoscopy were endoscopic and open surgical treatment of VUR, stent removal, and any other diagnostic reasons. Exclusion criteria were patients with: infravesical obstruction, neuropathic bladder, severe detrusor over activity/dysfunctional voiding, duplex system, paraureteral diverticulum, bladder exstrophy and grade-1 VUR. The 51 refluxing ureters (RUs) were compared with 55 non-refluxing ureters (NRUs). Finally, sensitivity, specificity, positive and negative predictive values, and accuracy rate of HD were evaluated.

RESULTS

A total of 106 ureters in 61 patients with a mean age of 5.3 ± 3.9 years (range 2 months-15 years, median 5 years) were prospectively assigned. The mean HD grade in the RUs was 2.17 ± 0.55. The mean HD grades were 2.0 ± 0.63, 2.07 ± 0.53, 2.38 ± 0.5 and 2.5 ± 0.57 for VUR grades 2-5, respectively. The mean HD grade in the NRUs was 1.60 ± 0.70. The HD grades were H0 to H3 in 7.3%, 30.9%, 56.4% and 5.4% of the NRUs, respectively. The RUs group (2.17 ± 0.55) showed a statistically higher HD grade than the NRUs group (1.60 ± 0.70) (P < 0.005). Sensitivity, specificity, positive and negative predictive values, and accuracy rate of HD grading in the diagnosis of VUR were 92%, 38%, 58%, 84%, and 64%, respectively. The mean HD grade in contralateral ureters of unilateral VUR was 1.55 ± 0.72 and HD grades were H0-H3 in 0%, 55.6%, 33.3% and 11.1% of these nine ureters, respectively. In these nine non-refluxing contralateral ureters, after endoscopic correction of ipsilateral VUR, new contralateral VUR did not occur.

CONCLUSION

Even though HD grade was high in the VUR group and popularity of the HD grading is on the increase, HD grading by itself still has a low diagnostic value.