Urethral plate grafting improves the results of tubularized incised plate urethroplasty in primary hypospadias

OBJECTIVE

We conducted a competitive efficacy trial in order to examine whether grafting the raw area of the urethral plate (UP) with inner preputial skin in children with primary hypospadias (PH) during tubularized incised plate urethroplasty (TIP) improves the results of the operation.

MATERIAL AND METHODS

Fifty consecutive patients with pathology ranging from glanular to proximal penile PH were randomized into two groups, comparable for age and pathology, to be operated on either with TIP or a grafted TIP (G-TIP) procedure. Three patients failed the re-examination protocol, so the TIP group comprised 23 children aged 9.0 months-9.6 years (mean age 3.4 years) and the G-TIP group comprised 24 children, aged 10.0 months-9.4 years (mean 3.5 years). The patients were followed up for a period of 2-5 years (mean 3.2 years).

RESULTS

Within the TIP group, we observed the development of fistula with concomitant neourethral stenosis in two cases (8.7%), stenosis without fistula in four (17.4%), and glans dehiscence in one case (4.35%). Within the G-TIP group there was one case of fistula without stenosis (4.16%), no case of neourethral stenosis, and one case of glans dehiscence (4.16%). Two cases of non-slit-like meatus were observed in the TIP group. The results show that the complications of neourethral stenosis are significantly reduced (p < 0.05) in the G-TIP group, as is the total number of complications and unsatisfactory results. The duration of the TIP operation was 72-110 (mean 92) min, and for the G-TIP 100-136 (mean 115) min. No postoperative symptoms were observed that could be attributed to prolonged anesthesia time.

CONCLUSION

UP grafting with inner preputial skin, when added to the TIP procedure in the treatment of PH, results in a significantly smaller number of unsatisfactory results, and particularly fewer cases of neourethral stenosis. G-TIP can be used as the procedure of choice in PH patients.

Volvulus of the transverse colon in a child: a case report

A case of transverse colon volvulus in a 10-year-old female child with trisomy 13 is reported, bringing the total number of cases of children reported in the English language medical literature to 14. Although this type of volvulus is rare, a definite pattern is noticeable, so we should suspect its diagnosis in a patient with chronic constipation, mental retardation and motor disturbances. Resection of the involved segment and primary anastomosis is the definite treatment.

Imperforate anus associated with atresia of the transverse colon: a case report

We describe here a rare case of association of imperforate anus with transverse colon atresia in a male neonate. Preoperative X-ray studies demonstrated: a) a distended loop in the epigastrium with fluid levels on plain A/P upright radiography, b) absence of pelvic intestinal gas on the invertogram 16 hours later. A three-stage operative approach was undertaken comprising resection of the atretic loop and colostomy, posterior sagittal anorectoplasty a few months later, and finally closure of the colostomy. The postoperative outcome was good. The association of these anomalies should be kept in mind in neonates with anal atresia and abdominal distention.

Embryonal/Fetal subtype hepatoblastoma: a case report

Hepatoblastoma is the most common primary liver tumor of childhood and after neuroblastoma and nephroblastoma the third most common abdominal neoplasm in this age group. Hepatoblastoma is an embryonal tumor classified by histology as epithelial (including pure fetal subtype, mixed embryonal/fetal subtype, macrotrabecular subtype and small cell undifferentiated subtype), mixed epithelial and mesenchymal type (with teratoid and non-teratoid features) and hepatoblastoma not otherwise specified. We present a case of a five-months old girl with embryonal/fetal subtype hepatoblastoma. The clinical presentation was asymptomatic abdominal mass. Ultrasound and MRI scan demonstrated a solid hepatic tumor. She presented thrombocytosis and serum alpha-fetoprotein was increased. A left lobe hepatectomy was performed and the pathological examination revealed complete excision of a mixed embryonalfetal subtype hepatoblastoma.

Mucoceles of the lesser salivary glands in neonates demonstrate a particular clinicopathological pattern and mandate urgent management

Mucoceles of the lesser salivary glands are common benign lesions affecting all ages, most commonly appearing on the lower lip. However, mucoceles in neonates demonstrate a different clinicopathological pattern than in older children or adults and mandate urgent management. We present a case of a large mucocele on the tongue of a neonate, which impaired feeding and could block the airway. The lesion was resected on the 3rd day of life. We describe a surgical technique that facilitates this procedure. Our literature review revealed 13 neonatal lesser salivary gland mucocele cases, 7 of which were located on the tongue. All tongue cysts were large, impaired feeding and sometimes blocked the airway. Early treatment is usually imperative. Inclusion cysts outnumbered extravasation cysts. Prenatal diagnosis is important in order to arrange delivery in an organized center. Resection is the preferable procedure.

Laparoscopic-Assisted Anorectoplasty for Anorectal Malformation With Recto-Prostatic Urethral Fistula: A Case Report and Review of the Literature

Congenital recto-urethral fistula is the most common form of anorectal malformation found in boys. The final repair includes the ligation of the fistula and the anorectoplasty, and can be achieved either way: posterior sagitally or laparoscopically. We present a case of a term male infant diagnosed with anorectal malformation and recto-prostatic urethral fistula, that underwent a laparoscopic-assisted posterior sagittal anorectoplasty in our department.

Surgical Management of Arteriovenous Malformation of the Penis in an Adolescent Boy: A Case Report and Review of the Literature

Arteriovenous malformations (AVMs) are common benign lesions, present at birth. Although they may occur anywhere in the body, usually they are found on the head, the neck, and the extremities. AVMs of the glans penis are very rare. Only a few have been reported in the literature, and thus, a definitive treatment does not exist. We herein report our experience of treating an AVM of the glans penis with surgical excision and plastic reconstruction of the glans, with the application of transplant tissue from the inner skin of the prepuce.

Bilateral Ureteral Obstruction in Children With Ulcerative Colitis and Oliguria: When and Why?

Inflammatory bowel disease (IBD) is an inflammatory clinical entity with many extraintestinal symptoms, including urinary tract manifestations. However, the bilateral ureteral obstruction is extremely rare. We report a case of bilateral ureteral obstruction in a 12-year-old male patient with ulcerative colitis (UC). Ultrasonography in the context of sudden anuria revealed bilateral ureterovesical junction (UVJ) obstruction, and the following cystoscopy verified the presence of fragile calculi in both edematous ureteral orifices. The literature data on UC in the pediatric population are scarce. Sudden deteriorating oliguria in an UC patient may result from secondary obstructive uropathy. Immediate diagnosis and treatment are essential to prevent acute kidney injury.

Endovascular Treatment With a Balloon-Expandable Covered Stent in a Polytrauma 12-Year-Old Patient With Traumatic Abdominal Aortic Rupture

Βlunt trauma is a common injury in children; however, blunt abdominal aortic trauma is extremely rare and is accompanied by high rates of morbidity and mortality. We report our initial experience with the endovascular management of an abdominal aortic rupture in a 12-year-old boy after he was involved in a motor vehicle accident. The patient was a backseat-restrained passenger. Upon admission, he had a Glasgow Coma Scale of 15, was hemodynamically stable, and complained of abdominal pain. The computed tomography revealed a rupture in the abdominal aorta along with a distally extending pseudoaneurysm, free fluid in the peritoneal cavity, and a large retroperitoneal hematoma. The rest associated injuries were a Grade III splenic injury, a retroclival epidural hematoma in the first cervical vertebra level, a right clavicle fracture, a bilateral minor pneumothorax, along with bilateral pulmonary lacerations and contusions in the thoracic vertebrae. Given the extent of the intraabdominal injuries and the risk for open laparotomy, the decision to proceed with endovascular stenting instead of open surgical repair was made. The patient tolerated the procedure well and an angiography confirmed the result. The postoperative period was uneventful and the associated injuries were treated conservatively without complications. Although blunt abdominal aortic trauma is extremely rare in children, endovascular management seems to be a new and feasible therapeutic approach.

Diagnosis and management of congenital neonatal chylous ascites

BACKGROUND

Congenital chylous ascites is a rare condition that constitutes a challenge for the physician. It is defined as the accumulation of chyle into the peritoneal cavity in infants younger than 3 months. This condition is often refractory to therapy and it is responsible for serious malnutrition and immunological deficiency because of the loss of proteins and lymphocytes.

MATERIAL AND METHODS

Four cases of congenital neonatal chylous ascites, were treated by our staff during the last two years. One case was treated conservatively and three with laparotomy. Two of them had intraabdominal cysts that were excised and one was treated with ligation of the left lumbar lymphatic trunk and cisterna chyli and the use of fibrin glue.

RESULTS

All four cases were treated successfully. On follow up tests no one showed recurrence of the ascites. All children, except the one that treated conservatively and also had other problems due to prematurity, are growing up normally.

CONCLUSIONS

Congenital chylous ascites is a complex condition. Its diagnostic evaluation is difficult and its therapy of long duration. Conservative treatment is in most cases the initial choice, but when it fails, exploratory laparotomy could provide a successful alternative.

A Rare Case of Iatrogenic Urinary Bladder Injury During Inguinal Hernia Repair: Management Tips, Tricks and Pitfalls

Iatrogenic injury of the bladder is a rare incidence during inguinal hernia repair in children, with serious consequences for such patients. Due to the scarcity of information on this matter, it is our goal to share our experience regarding the therapeutic approach to such a rare occurrence. Specifically, a 22-month-old male was admitted to our department with the complaint of vomiting, abdominal pain and anuria, two days after inguinal hernia repair. The child had distention of the inguinal hernia region and was lethargic. The diagnostic investigation did not reveal any significant findings. During surgical exploration, we discovered an injury to the bladder, while a large part of the dome of the bladder was ligated and subsequently became necrotic. After a reoperation and an enduring postoperative course, the patient finally recovered. Currently, the child is under observation. Therefore, it is of paramount importance for pediatric surgeons to be acquainted with the potential for bladder injury during inguinal hernia repair, ways to manage this complication, and various issues that may emerge during the therapeutic process.