ESPU Meeting on Thursday 9, June 2022, 16:20 - 16:55
16:20 - 16:25
University Medical Centre Mannheim, Center of Pediatric, Adolescent and reconstructive Urology, Mannheim, GERMANY
A now 3.5 year old boy was born with a lower urinary tract obstruction (most probably to a hypo-/dysplastic urethra +/- PUV) and renal insufficiency.
He received a vesicostomy soon after birth and later he needed peritoneal dialysis. In January 2021 he underwent renal transplantation into his vesicostomy as well as nephrectomy of both kidneys in another hospital. At the age of three years he showed up again for reconstruction of the urethra/PUV-Incision. During urethroscopy, a very narrow urethra was found again and after some discussion, we decided not to reconstruct the urethra in that age due to symptomatic reflux in his transplant kidney, the age and development of the child (not willing to void through the urethra or leaving a catheter through the stoma). During the next months the child again hat recurrent pyelonephritis with increasing creatinine (1mg%) , so the decision was made to do an antireflux procedure and the patient was admitted with a new pyelonephritis with pseudomonas. After antibiotic treatment antireflux operation was done.
During the operation, a well vascularized urethra and relative smooth bladder wall was seen with a direct implantation of the ureter into the bladder. So the decision was made to do a modified Lich Gregoir technique without detaching the urethra from the bladder mucosa. A 3-4 cm long tunnel was made. 3 Days after surgery the creatinine raised to 1.8 mg% and the urine output went down. He received a nephrostomy tube and the creatinine went very slowly down again to 1.0 mg%. within the next days. In the antegrad filling 2 weeks after the operation no obstruction was seen and after clamping the nephrostomy tube no increase of the creatine was observed. He was discharge 4 weeks after admission with a creatinine of 0.9 mg%.
Ureteroneocystostomy with stenting would have been the better choice?
16:28 - 16:33
Sadaf ABA UMER KODWAVWALA
Sindh Institute of Urology & Transplantation, Philip G. Ransley Department of Paediatric Urology, Karachi, PAKISTAN
A suprapubic catheter is an effective way for long-term drainage of the urinary bladder. Obstruction of ureteric orifice due to suprapubic catheter is a rare complication. Timely recognition can avoid fatal outcomes.
A 15-year-old boy, case of exstrophy epispadias complex with renal failure, on suprapubic catheter drainage for one year, presented to ER with left flank pain and gross hematuria for 2 days. He had history of suprapubic catheter replacement a day before symptoms. Investigations showed left gross hydronephrosis with echogenic material (blood clots), perinephric collection and blood clots in the urinary bladder. After optimization, he underwent left exploration. On 7th Postoperative day, his Suprapubic catheter was replaced as accidentally dislodged. A day later, he developed right flank pain and gross hematuria. Ultrasound showed dilated right PCS and urinary bladder full of echogenic material. A PCN was placed in the right kidney. On cystoscopy during bladder clots evacuation, the Tip and balloon of suprapubic catheter were found inside the dilated right ureteric orifice. On deflating and removing the tip of catheter from ureteric orifice, a gush of hematuria drained from the right kidney (video available). Gradually right-sided Pelvicalyceal system drained completely and collapsed.
In patients with suprapubic catheter drainage, sudden onset of flank pain and increasing hydronephrosis should raise the suspicion of ureteric obstruction. Healthcare professionals who are involved with suprapubic catheter placement should be aware of this potential complication.
16:36 - 16:41
C.D. Anthony HERNDON
Virginia Commonwealth University, Surgery/Urology, Henrico, USA
A 2.5 year-old female presented after multiple febrile UTI with a massive intravesical duplex system ureterocele. Pre-operatively the patient was prep for the cystoscopy with Hibcleans(4% chlorhexadine) soap and the abdomen was prepped with Chorlorprep(2% chlorhexidine). The cystoscopy was remarkable for a ureterocele that filled the entire bladder. During open repair, the ureterocele was excised and bilateral Cohen reimplantations were performed. Towards the end of the procedure a small area of epidermis on the mons peeled up and a Tegaderm was applied with the belief it was due to tension from a suture. At the end of the procedure however, it became clear that entire area involving the cysto prep was excoriated. The Burn team was consulted. The following morning she had developed what appeared to be toxic epidermolysis over the entire mons pubis. Over the course of two weeks, she continued to demonstrate signs of second-degree burn/severe allergy to the point where the entire Mons pubis was debrided and required STSG. She has recovered well and it still unclear if this represented a delayed hypersensitivity or chemical burn.
16:44 - 16:49
Riley Hospital for Children, Urology, Indianapolis, USA
Laparoscopic division of a rectourethral fistula has proven highly effective in patients with imperforate anus. However, injury to the bulbar urethra or bladder neck can occur. We describe a 8-month-old patient in whom division of the rectourethral fistula tract resulted in a gross violation of the bulbar urethra and subsequent leak.
Upon identifying this complication, attempts were made to gain endoscopic access into the bladder. However, the diameter of the urethra would not allow passage of a flexible eight French ureteroscope. Open surgical repair was considered. In leu of an open approach, the injury was managed successfully by passage of a 0.18 curved glide wire per urethra into the bladder. This was achieved by hugging the anterior wall of the urethra while observing the posterior urethra from a laparoscopic perspective. On the first two attempts the wire passed out of the bulbar urethra and into the abdomen. However, on the third attempt we were able to rotate the curved glide wire in to position and pass it across the urethral defect and into the bladder. A six French silastic stent was subsequently threaded over the wire into the bladder with good urine return. The catheter was sewn to the glans penis with two 5-0 prolene sutures. A pull out voiding cystogram performed four weeks later demonstrated complete resolution of the leak with no evidence of stricture. An ultrasound performed one year later revealed no evidence of urinary tract obstruction. The child has been asymptomatic and free of infection.