Renal dysplasia with single system ectopic ureter: Diagnosis using magnetic resonance urography and management with laparoscopic nephroureterectomy in pediatric age

Scrotal abscess: Varied etiology, associations, and management

Aim:

To report a series of scrotal abscess, a rare problem, their etiology, and management.

Materials and Methods:

A retrospective study of children who presented with scrotal abscess between January 2010 and March 2015, analyzed with respect to clinical features, pathophysiology of spread and management.

Results:

Eight infants and a 3-year-old phenotypically male child presented with scrotal abscess as a result of abdominal pathologies which included mixed gonadal dysgenesis (MGD) [1]; three anorectal malformations with ectopic ureter [1], urethral stricture [1], and neurogenic bladder [1]; meconium peritonitis with meconium periorchitis [2], ileal atresia [1], and intra-abdominal abscess [1]; posturethroplasty for Y urethral duplication with metal stenosis [1] and idiopathic pyocele [1]. Transmission of the organism had varied routes include fallopian tube [1], urethra ejaculatory reflux [4], hematogenous [2], and the patent process of vaginalis [2]. Two of the nine required extensive evaluation for further management. Treating the predisposing pathology resolved scrotal abscesses in eight of nine patients, one of whom, required vasectomy additionally. Idiopathic pyocele responded to needle aspiration and antibiotics.

Conclusion:

Scrotal abscess needs a high index of suspicion for predisposing pathology, especially in infants. Laparoscopy is safe and effective in the management of the MGD and ectopic ureter.

Rare cause of adult female incontinence: complete duplication of the collecting system and ectopic ureter of the kidney draining into the vagina treated by laparoscopic upper pole heminephrectomy and ureterectomy

A 38-year-old woman presented with a lifelong history of involuntary urinary leakage. The patient reported that she had been operated for her urinary leakage with the diagnosis of stress incontinence with transobturator tape two times at two different institutions. Preoperative computed tomography scan showed complete duplication of the left kidney with poorly functioning upper pole and a tortuous left dilated ureter running down and opening into the vagina. Laparoscopic left upper pole heminephrectomy and ureterectomy were performed uneventfully. Her incontinence improved immediately after surgery.

Single trocar retroperitoneoscopic nephrectomy for dysplastic poorly functioning kidney with ectopic ureter in children

This is the first report of a single trocar nephrectomy for poorly functioning dysplastic kidney and ectopic ureter, performed in 5 patients from 2010 to 2011. The mean operative time was 63 min and mean postoperative hospital stay was 31 h. There were no perioperative complications. The single trocar nephrectomy is a feasible and safe procedure for patients with dysplastic kidney and ectopic ureter.

Male infant with a single-system ectopic ureter that required the removal of the ureteral stump after nephrectomy

The necessity of removing ureteral stumps after upper tract surgery for ectopic ureters has been debated, because the procedure can be difficult to carry out and might cause injury to bladder continence mechanisms. Fortunately, ureteral stumps rarely cause problems. We herein report the case of a single-system ectopic ureter that required the removal of the ureteral stump after nephrectomy. In our case, reflux into the ectopic ureter adversely affected the dilation of the ureteral stump. Although urine might flow through an ectopic opening during the voiding phase as a result of high pressure, residual urine might be unable to flow during the storage phase because of low pressure in the ureteral stump. The removal of ureteral stumps might be required in patients with reflux into ectopic ureters. When surgical intervention is necessary for patients with megaureters, cystourethroscopy should be carried out to more accurately clarify the anatomy of the lower urinary tract.

A 12-year-old boy with an infected ectopic ureter presenting with acute appendicitis-like symptoms and acute scrotum

An ectopic ureter draining into the seminal vesicle or vas deferens in males is a very rare anomaly and is usually associated with renal dysplasia or agenesis. An ectopic ureter associated with a dysplastic kidney is not usually a suspected cause during clinical evaluation of children with abdominal pain. This report presents a rare case of an ectopic ureter associated with a dysplastic kidney with an acute infection in a previously healthy 12-year-old boy, demonstrated by magnetic resonance imaging. He presented with abdominal pain that mimicked acute appendicitis-like symptoms which was subsequently complicated by epididymitis manifesting as an acute scrotum. Clinicians should consider including an ectopic ureter in the differential diagnosis of children presenting with acute abdomen.