Early pyeloplasty versus conservative management of severe ureteropelvic junction obstruction in asymptomatic infants

BACKGROUND

Ureteric-pelvic junction obstruction (UPJO) is the most common cause of antenatal and neonatal hydronephrosis and its management remains controversial. While conservative management is advocated for all, this strategy puts a quarter of these patients at risk for possibly irreversible renal damage.

AIM

In this study, we compare functional and anatomic outcomes in newborns and infants less than 1 year of age with high-grade unilateral UPJO, following early surgical pyeloplasty (ESP) versus conservative management (CM).

MATERIALS AND METHODS

This was a single center prospective interventional study. Infants referred to our tertiary care pediatric surgery clinic between September 2016 and September 2018 with UPJO were considered. To be included patients must have been less than 1 year old, lack of clinical symptoms, suffer from severe hydronephrosis as defined by Society for Fetal Urology (SFU) grades 3 or 4, and have affected kidney Split Renal Function (SRF) above 40%. Patients with bilateral disease, structural anomalies, or an abnormal voiding cystourethrogram (VCUG) were excluded. Anatomical and functional outcomes were measured and compared at 6 and 12 months.

RESULTS

Fifty-six patients were assigned to receive either ESP (n = 28) or CM (n = 28). At 6 months Cortical thickness, polar length, and SFU indices were significantly lower in the ESP group, while none of the outcomes were significantly different between the two groups at 12 months. Despite the two groups not being different at 12 months regarding differential renal function (DRF), there was a significant decrease of function in the CM group compared to baseline.

CONCLUSION

When considering treatment options for infants with high-grade UPJO, it appears that ESP hastens improvement of anatomic and functional indices, while CM may lead to a significant deterioration in renal function.

Congenital Umbilical Appendix Misdiagnosed as Umbilical Granuloma: Report of 2 Cases

Background: Umbilical cord hernia is an uncommon umbilical anomaly which develops during 10th to 12th weeks of gestational age owing to failure of complete bowel return into coelomic cavity. In extremely rare cases appendix is the only trapped organ in hernia sac which may erode the overlying membrane and simulate umbili-cal granuloma. Case Report: Two infants presented with delayed umbilical cord separation with a reddish mass at umbilicus which was initially diagnosed as umbilical granuloma. Surgical exploration on failure of conservative measures revealed it as vermiform appendix. Appendectomy was done in both cases. Conclusion: Vermiform appendix at umbilicus is a rare congenital anomaly and may simulate other pathologies at umbilicus.

The outcome and complications of modern staged repair surgery in newborns with classic bladder exstrophy in different genders: A retrospective study

INTRODUCTION

Classic bladder exstrophy (CBE) is a rare anterior midline birth defect that remains a challenge for pediatric surgeons. Despite multiple reconstructive methods, outcomes vary widely in various reports. This study aims to compare the success rate and complications of modern staged repair of exstrophy (MSRE) in each gender and compare together.

METHODS

This retrospective cross-sectional study included cases of CBE between 2010 and 2020 that underwent MSRE. Short-term follow-up results, including incontinence rate, vesicoureteral reflux (VUR), urinary infections, deformed genitalia, and so on, were measured in each gender, and their differences were reported.

RESULTS

Among the 40 newborns with CBE who underwent MSRE, 25 (62.5%) were boys, while the others had non-male genitalia. The rates of incontinence, VUR, dehiscence, and fistulas did not differ significantly between genders. However, chronic urinary tract infections (UTIs) were more frequent in girls, and boys were more likely to have malformed genitalia (p < .05).

CONCLUSION

Our findings indicate a similar rate of complications in each gender. However, chronic UTIs and external genitalia deformities were significantly more common in girls and boys, respectively. Further large-sized controlled trials may be needed to corroborate these findings.

Types and frequency of ovarian masses in children over a 10-year period

BACKGROUND

Ovarian masses represent a range of pathology from benign cyst to highly aggressive malignant tumors. It has been estimated that gynecologic malignancy account for approximately 2% of all types of cancer in children, 60-70% of these lesions arise in the ovary.

METHODS

All ovarian masses which were resected or biopsied in Mofid Children's Hospital from 2002 to 2012 were reviewed retrospectively. Patient's age, presenting symptoms, surgical procedures, pathological diagnosis, postoperative treatment, and outcome were obtained from medical records.

RESULTS

Fifty-seven girls (aged 40.2±57months with the range of 1 day to 15 years) underwent different types of ovarian operations (24 salpingo-oophorectomies, 10 oophorectomies, 21 ovarian cystectomies, and 2 ovarian biopsies). 50 children had unilateral ovarian mass (49.1% right and 38.6 left, respectively). The most common presenting symptoms were acute abdominal pain in 46%.Twenty one (37%) of our patients had ovarian torsion. Four (7%) patients had benign tumors, and 8 (14%) had malignant tumors. There were no age differences between those with benign type (8.2±2.6years) and malignant tumors (6.1±5.3years) (P=0.683).

CONCLUSION

Ovarian tumors are rare in children. Most are benign, in children presenting with acute abdominal pain, ovarian mass particularly neoplastic tumors should be suspected. An important proportion of these patients may require postoperative chemotherapy.

Complete Urethral Duplication in Children: A Case Report

INTRODUCTION

Urethral duplication (UD) is a rare congenital anomaly with multiple anatomical variants.

CASE PRESENTATION

In this article we present a four year-old child with complete UD. The patient was admitted for hypospadias repair, in evaluation we found type IIA1 UD according to Effmann classification. Patient underwent hypospadias repair saving complete UD.

CONCLUSIONS

After one year follow-up he has normal and continent urination.

Gastric Duplication Cyst in Association with Duodenal Atresia in a Neonate

Concurrence of duodenal atresia and gastric duplication cyst is extremely rare entity. We report a 6-day-old female neonate who presented with neonatal intestinal obstruction. X-ray abdomen showed double bubble sign. At laparotomy, a huge cystic structure attached to greater curvature of the stomach along with duodenal atresia of second part of duodenum was found. The cystic structure was excised and duodeno-duodenostomy performed. Histopathology report confirmed it gastric duplication cyst.