ESPU Meeting on Wednesday 19, April 2023, 14:45 - 15:45
14:45 - 14:49
S02-1 (CP)
Venkata JAYANTHI 1, Molly FUCHS 1 and Kevin KLINGELE 2
1) Nationwide Children's Hospital, Department of Urology, Columbus, USA - 2) Nationwide Children's Hospital, Department of Orthopedics, Columbus, USA
PURPOSE
Postoperative immobilization is an essential aspect of post-operative care in children who have undergone bladder exstrophy closure. Techniques for immobilization classically have included traction, external fixators, or hip spica casting. We wish to present our initial experience with a novel method of using an orthotic brace custom fit for the specific child.
MATERIAL AND METHODS
A static, custom fit orthosis was fabricated preoperatively to hold the hips and knees at 90 degrees of flexion and neutral abduction/adduction. Children underwent a complete primary repair, meaning bladder mobilization, bladder neck repair and urethroplasty. Bilateral anterior iliac osteotomies were done after bladder closure. After final skin closure the child was placed in the brace, the abdomen and lower extremities were fastened via padded Velcro straps, and the child awakened. The child was kept on bedrest for 48 hour after which the parents were able to hold the child. The catheters were left to "double diaper" drainage 48 hours after surgery. The brace and the catheters were removed at the same visit 4 weeks after surgery.
RESULTS
Two girls (7 and 9 months of age) underwent primary closure with postoperative immobilization using the brace. Hospital stays were 5 and 7 days respectively. Incisions healed well and there were no perioperative complications. Subjectively, parents noted that wound care and diaper changes were not excessively challenging, since the abdomen and perineum were easily accessible while the child was in the brace.
CONCLUSIONS
This novel method for post-operative immobilization after exstrophy closure has numerous advantages over more commonly used approaches. It is easy to apply, requires no operative time and the abdomen is exposed for wound inspection. Excessive post-operative swelling of the abdomen or legs can be managed by loosening the velcro straps.
14:49 - 14:53
S02-2 (CP)
Grzegorz KUDELA 1, Dariusz BASEK 1, Agnieszka WIERNIK 1, Magdalena JASTRZĘBSKA 1, Karolina KOWALCZYK 2, Agnieszka DROSDZOL-COP 2 and Tomasz KOSZUTSKI 1
1) Medical University of Silesia, Katowice, Poland, Department of Pediatric Surgery and Urology, Katowice, POLAND - 2) School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland, Chair and Department of Gynecology, Obstetrics and Gynecological Oncology, Katowice, POLAND
PURPOSE
Cloaca is a complex defect requiring detailed preoperative planning and individual approach. Aim of our study is to present diverse reconstruction techniques in cloacal malformations.
MATERIAL AND METHODS
Medical records of three patients treated for cloacal malformation in our clinic in the last year have been analyzed and presented.
RESULTS
In all patients colostomy and vesicostomy/vaginostomy were created. The first patient was disqualified from reconstruction in the other center due to the significant length of the common channel, very short urethra and the sacral agenesis. In our center (at the age of 3) only PSARP was performed, during which the vagina and the bladder were cut off from the common channel. After colostomy reversal proper bowel control was achieved. In puberty (13 years), the vagina became distended and lowered[GK1] , which enabled successful reconstruction of the patent vagina, vestibule and vulva. In the second patient, with a 3 cm common channel and a 2 cm urethra, PSARPUVP with total urogenital mobilization was performed in infancy. In the third patient, with a 3 cm common channel and a short 1 cm urethra, PSARPUVP was also performed, separating the vagina from the common channel and reconstructing a urethra from the distal portion of the cloaca. None of the patients required laparotomy or vaginal replacement. The short term results are satisfactory.
CONCLUSIONS
Simultaneous reconstruction of the entire malformation is the best treatment option. Nevertheless it is possible to reconstruct rectum separately in a young child and the vagina later in puberty.
14:53 - 14:57
S02-3 (CP)
Süleyman TAĞCI, Gökhan DEMIRTAŞ, Bilge KARABULUT and Hüseyin Tuğrul TIRYAKI
Ankara City Hospital, Pediatric Urology, Ankara, TURKEY
PURPOSE
The standard treatment for hydrocephalus is either a ventriculoperitoneal or a ventriculo-atrial shunt(1). However, shunt malfunction, recurrent infection or other co-morbidities occasionally make these shunts inappropriate (2). In a constant search for alternatives, surgeons have placed the shunts in different cavities and organs in the body, including the pleura, fallopian tube, ureter, stomach, and gallbladder(3). We will share our experience with ventriculovesical shunt, which is a rare method in the treatment of hydrocephalus.
MATERIAL AND METHODS
A 3 month-old male patient underwent ventriculoperitoneal shunt operation when he was a month old due to hydrocephalus. however, he did not respond to treatment because peritoneal drainage capacity was not sufficient (picture 1).
RESULTS
He was referred to us by the neurosurgery clinic for ventricular vesical shunt placement.The distal end of the vp shunt placed in the previous operation was removed from the peritoneum. The layers were passed with the right groin incision. The distal end of the shunt was taken into the bladder , creating a submucosal tunnel, from the right side wall of the bladder.The catheter is anchored to the back of the bladder with a suture, leaving a 15 cm free inside and outside the bladder lumen (picture 2). In the 2 month follow-up, the patient's head circumference decreased from 67 cm to 58 cm. No complications were detected.
CONCLUSIONS
We argue that ventriculovesical shunt can be performed successfully when necessary in the treatment of hydrocephalus.
14:57 - 15:01
S02-4 (CP)
Ahmet Furkan SARIKAYA 1, Cemile PEHLIVANOGLU 2, Ersin KOSEOGLU 1, Kayhan TARIM 1, Murat Can KIREMIT 1 and Tayfun Mevlut OKTAR 1
1) Koç University School Of Medicine, Urology, Istanbul, TURKEY - 2) Koç University School Of Medicine, Pediatric Nephrology, Istanbul, TURKEY
PURPOSE
Chyluria is a extremely rare condition in childhood and classified into parasitic and non-parasitic causes. Non-parasitic causes include infections, mechanical obstructions and trauma. Conservative management, endoscopic sclerotherapy and surgery are main treatment options but gold standart option is still controversial. Povidone iodine is one of the efficient sclerosing agents for the management of this rare entity.
MATERIAL AND METHODS
A 12-year-old boy was admitted with intermittent milky urine for 4 months after falling off his bike. Physical examination was unremarkable. Spot urine protein level, protein/ creatinine ratio and 24-hour urine sample protein level were 836.7 mg/dl (1-16), 8531 (n: 59-220) and 100 mg/dl (normal range: 0-25), respectively. The urine culture was sterile. No etiological factor was detected on imaging modalities.
On cystoscopy, chyluria-related clots, a milky urine jet excreting through the right ureteral orifice were detected. Bilateral retrograde pyelography was performed and an extravasation indicating pyelolymphatic communication was detected from the superomedial side of right renal pelvis by fluoroscopy.
A 1 ml of 10% povidone iodine, diluted with 10 ml of distilled water was instilled via ureteral catheter and administered for 5 minutes.
RESULTS
The milky urine totally disappeared on the first postoperative day and was stable in the three- month follow-up. The spot and 24-hour urine samples were normal
CONCLUSIONS
Endoscopic sclerotherapy with povidone iodine for chyluria is a feasible, safe and effective treatment option, when conservative management was unsuccessful.
15:01 - 15:05
S02-5 (CP)
Mehmet Ugur YILMAZ 1, Bilge TUREDI SEZER 1, Serdar GUNDOGDU 2, Melike EVIM SEZGIN 3, Mehmet Fatih INECIKLI 4, Nizamettin KILIC 1 and Mehmet Emin BALKAN 1
1) Uludag University, Paediatric Surgery- Division of Paediatric Urology, Bursa, TURKEY - 2) Uludag University, Paediatric Surgery, Bursa, TURKEY - 3) Uludag University, Department of Pediatrics- Division of Pediatric Hematology, Bursa, TURKEY - 4) Uludag University, Department of Radiology, Bursa, TURKEY
PURPOSE
Pediatric abdominal trauma can be life-threating in patients with bleeding disorders . We aimed to present the successful endovascular management of a patient with hemophilia after blunt abdominal trauma.
MATERIAL AND METHODS
Fourteen year-old girl with combinated factor V-VIII deficiency had a history of hitting the right part of her body to the pole during a volleyball match at school. She had multi-organ injuries consisting contusion of right lung, grade 4 right renal injury and grade 2 liver injury. Since she was hypotensive and tachycardic despite adequate fluid ressuscitation, she was immediately transferred to intensive care unit. Blood transfusion and factor replacement was made according to recommendations of pediatric hematology team. Lung and liver injury was stable on control examinations and radiologic imaging. On the second day, due to progressive decrease in serial checked hemoglobin-hematocrit levels and being hemodynamically unstable despite adequate blood transfusions and factor replacement, interventional radiology consultation was made. In angiographic evaluation, multiple bleeding foci from segmental branches of lower right pole were detected. Superselective embolisation was performed by adjusting 10% concentration of N-butyl cyanoacrylate and lipiodol mixture.
RESULTS
Two days after procedure,her hemodynamical status improved . After 9 days of surgical follow-up, she was transferred to pediatric hematology service for factor replacement and than discharged after recovery. 2nd month DMSA(dimercaptosuccinic acid) scan revealed normal left kidney and right kidney had just visible upper pole. The middle and lower pol of right kidney wasn't visible on DMSA scan. (left:%83, right:%17). Now she is within 10 months follow up and has no problem.
CONCLUSIONS
It can be safely managed with minimally invasive endovascular methods, multidisciplinary approach and appropriate blood product and factor replacement in children with bleeding disorders such as hemophilia, in persistent bleeding that disrupts hemodynamics due to renal trauma.
15:05 - 15:09
S02-6 (CP)
Filippo INCERTI, Giulia MOTTADELLI, Francesco DE LEO, Luciano SANGIORGIO, Claudio CARLINI and Alessio PINI PRATO
Children Hospital of Alessandria, Alessandria, ITALY
INTRODUCTION AND PURPOSE
Blunt testicular traumas represent a quite frequent entity in pediatric population. EAU guidelines recommend urgent surgical exploration in case of suspected testicular rupture, with closure of the tunica albuginea. However, tunica albuginea repair could be impossible due to retraction of its flaps especially in non-recent events. Herein, we present an alternative technique for albuginea infraction repair in testicular blunt trauma.
CASE DESCRIPTION
A 10-year-old boy was referred to our Emergency Department for a 5-days history of right scrotal trauma, falling on his bicycle crossbar while running. He presented with a clinical acute scrotum, scrotal ultrasound showed irregularity of tunica albuginea with suspicion of rupture and urgent scrotal exploration was performed. Intraoperatively, after hematoma removal, we confirmed complete rupture of tunica albuginea and exposure of the entire inferior half of testicular parenchyma, with complete retraction of albugineal flap. No direct repair was possible.
SURGICAL TECHNIQUE AND OUTCOME
Two vaginal pediculate flaps were obtained by blunt and cut dissection. They were positioned to cover the albugineal defect and fixed to albuginea with readsorbable running sutures. A small laminar drain was left for 24 hours and the patient was discharged on second postoperative day. Ultrasound with Doppler examination was performed 45 days after surgery and showed regular right gonad with normal blood flow.
CONCLUSIONS
Vaginal pediculate flap is a feasible option for albugineal replacement in pediatric blunt testicular trauma. Clinical and radiological examination show satisfactory result in short-term follow-up.
15:09 - 15:13
S02-7 (CP)
Ana RAMIREZ CALAZANS, Jesús GONZÁLEZ CAYÓN, Alberto PARENTE HENÁNDEZ, Verónica VARGAS CRUZ, Alvaro ESCASSI GIL and Maria Rosa PAREDES ESTEBAN
HOSPITAL REINA SOFÍA DE CÓRDOBA, PEDIATRIC SURGERY, Málaga, SPAIN
PURPOSE
Recurrent orchiepididymitis secondary to urethroreferential reflux is a rare cause of acute scrotum and its management continues to be a therapeutic challenge due to the lack of consensus on its treatment. We present our experience in the endoscopic treatment of recurrent orchiepididymitis.
MATERIAL AND METHODS
Three patients with recurrent orchiepididymitis treated endoscopically between 2020-2022. Mean age of 9 years (3-12 years). Two patients had a neurogenic bladder secondary to myelomeningocele. All patients presented at least 3 episodes of right orchitis before the intervention. The endoscopic treatment consisted of an exploratory cystoscopy with a 9.5 Fr cystoscope and the injection of Macroplastique® subejaculatory at the level of the veru montanum.
RESULTS
Prior to performing the procedure, normal positioning of the ejaculatory orifices was observed, with increased amplitude of them. No patient presented immediate postoperative complications. The mean follow-up time was 13 months (3-28 months). During the follow-up, 66.6% of the patients, presented good clinical evolution, without any recurrence. The third patient presented two new episodes of right-sided orchitis at 6 and 24 months after performing the endoscopic procedure and is currently waiting for a second injection.
CONCLUSIONS
Endoscopic treatment of urethrodeferential reflux is presented as a minimally invasive and relatively effective therapeutic option for recurrent orchiepididymitis. However, although the success rate of this technique and its results are promising in our series, a larger sample size is necessary
15:13 - 15:17
S02-8 (CP)
Grzegorz KUDELA 1, Agnieszka DROSDZOL-COP 2, Karolina KOWALCZYK 2, Agnieszka WIERNIK 3 and Tomasz KOSZUTSKI 3
1) Medical University of Silesia, Katowice, Poland, Department of Pediatric Surgery and Urology,, Katowice, POLAND - 2) School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland, Chair and Department of Gynecology, Obstetrics and Gynecological Oncology, Katowice, POLAND - 3) Medical University of Silesia, Katowice, Poland, Department of Pediatric Surgery and Urology, Katowice, POLAND
PURPOSE
Congenital vesicovaginal fistula is a very rare cause of menouria. Histerectomy has been often suggested in such cases, although there are some reports of uterine preservation. We present a rare case of successful laparoscopic treatment of uterus didelphys, distal vaginal agenesis and bilateral vesicovaginal fistulas.
MATERIAL AND METHODS
A 13-year-old girl was referred because of cyclic lower abdominal pain for 12 months. She presented menouria, adequate puberty stage, and normal 46,XX karyotype. Gynecological exam showed vaginal atresia with a vaginal dimple of 2 cm length. MRI revealed uterus didelphys, left hematosalphinx, hematocolpos below the right uterus with suspected narrow communication to the bladder. Bilateral vesicovaginal fistulas close to the ureteral orifices were confirmed on cystoscopy. Visualisation of right cervix and proximal part of the right vagina was possible by cystoscope through the patent right fistula whereas the left fistula was practically occluded.
RESULTS
Laparoscopic left hemi-hysterectomy and salphingectomy was performed, whereas on the right side vesicovaginal fistula was excised, proximal vagina was pulled through to the dimple and connected with it at the level of the vaginal vestibule. Postoperative recovery was uneventful. Neo-vaginal dilation was started on the 10th postoperative day. The patient has been painless and menstruating regularly from the right uterus since the operation.
CONCLUSIONS
Preservation of the uterus should be considered in any case of Mullerian duct anomaly. Surgical treatment must be individualized. However, presented case advocates that a minimally invasive approach is feasible.
15:17 - 15:21
S02-9 (CP)
Alexis ARNAUD 1, Paul GIRARD 2, Tristan BEAUFILS 2 and Nicolas BERTHEUIL 2
1) University Hospital of Rennes, Pediatric Surgery, Rennes Cedex 2, FRANCE - 2) University Hospital of Rennes, Plastic and reconstructive surgery, Rennes Cedex 2, FRANCE
PURPOSE
Cripple hypospadias is a surgical challenge for pediatric urologists. Many techniques have been described but none using free flaps.
MATERIAL AND METHODS
We report the case of an 18years old boy born with a proximal hypospadias. He has been operated on 3 times in infancy: Koyanagi procedure at 2y complicated by a complete dehiscence, then a 2 steps Bracka technique using buccal mucosal graft at 4y complicated by a sub coronal uretrocutaneous fistula. He presented at our clinic at 15y with a 90° penile curvature and no possible sexual intercourse. A step by step strategy was proposed. We first performed penile straightening using uretral plate transection and ventral lengthening of the corpus cavernosum. The second step was a Duplay urethroplasty 18 months later, complicated by 2 uretrocutaneous fistula. Considering the lack of skin on the penile shaft, a skin flap was proposed.
RESULTS
A superficial circumflex iliac artery perforator super thin SCIP flap was harvested. As the vessels were to short to allow a good coverage of the penis, the flap was freed out, and the left inferior epigastric vessels were harvested laparoscopically. The flap was then anastomosed to the epigastric vessels and used for skin coverage as a free flap over a redo Duplay urethroplasty. Procedure duration was 12hours and hospital stay 10 days. The postoperative course was uneventful. At 3 months postoperative, there is no uretral fistula, the flap is well vascularized and the penis is straight. The flap still requires physiotherapy to make it thiner.
CONCLUSIONS
This procedure offers a viable alternative for skin coverage for refractory urethrocutaneous fistula repair in cripple hypospadias with lack of skin.
15:21 - 15:25
S02-10 (CP)
Ganesh VYTHILINGAM 1, Abraham CHERIAN 2 and Usman ALI 3
1) Great Ormond Street Hospital, Paediatric Urology, London, UNITED KINGDOM - 2) Great Ormond Street Children Hospital, Urology, London, UNITED KINGDOM - 3) Great Ormond Street Children Hospital, Anaesthesia, London, UNITED KINGDOM
INTRODUCTION
Epidermolysis Bullosa (EB) is a rare, inherited skin disorder, characterized by marked mechanical fragility of epithelial tissues and continuous development of non-inflammatory blisters. We present the surgical strategy in the management of a child with extensive EB of the genitourinary tract.
MATERIAL AND METHODS
11-year-old Ex Prem 29/40, EB-Junctional type with multiple co-morbidities and bilateral end ureterostomies had persistent bilateral hydroureteronephrosis, recurrent UTI, and worsening CKD. The disease had extensively involved the urethra, bladder and ureter. The entire ureter on the right, and two thirds of the ureter on the left were substituted using an integrated ileal segment as for the augmentation cystoplasty using the “FEZ” technique. A posterior appendix mitrofanoff was also fashioned in the midline.
RESULTS
All peri-operative guidelines for the care of EB was utilized in his care leading to intact skin and mucosal integrity. Patient had an uneventful post operative period and was discharged day 20 post-surgery. He was started on training to utilize his mitrofanoff 10 days later. On last review prior to returning home on post Day 33 he was well with clean intermittent catheterization well established. The histology of his ureter and bladder specimens was consistent with extensive inflammation and fibrosis.
CONCLUSIONS
Although interventions and intubations of the urinary tract have to be carefully considered in genitourinary EB, at times a major reconstruction will be required and provides a much better pragmatic solution as in our patient.
15:25 - 15:29
S02-11 (CP)
Pauline LOPEZ, Matthieu PEYCELON, Alaa EL GHONEIMI and Annabel PAYE JAOUEN
Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Robert Debré, APHP, University of Paris Cité, Paris, FRANCE
PURPOSE
Urethral duplication is an extremely rare condition in girls and most of the time associated with other malformations. Few studies report long term follow-up after surgical treatment. We present three cases of urethral duplication in girls with long term follow-up for one of them.
MATERIAL AND METHODS
Data were collected retrospectively from records of three girls with urethral duplication managed over the last fifteen years. Diagnosis, type of malformation, management and outcomes were analyzed.
RESULTS
All the patients had a prenatal diagnosis of urogenital malformation with enlarged well-circumscribed fluid-filled vulvar cyst. At birth, clinical examination revealed a large cyst covering the clitoris corresponding to the accessory duct. Case 1 and 2 had a urogenital sinus and a Case 3 had a cloacal malformation. Case 2 had a anteriorly placed anus.
Resection of the accessory urethra and vulvoplasty was done for all of them at a median (IQR) age of 6.2 (4.3-6.8) months. For Case 1 and 3 a total urogenital sinus mobilization was done, and a partial one for Case 2. The cloacal malformation was managed with a neonatal colostomy and resection of the accessory urethra was done at the same time of mobilization and anoplasty. Colostomy was closed in a delayded procedure.
For Case 1, follow up is 13 years and 18 months for the others two patients.
Follow-up was uneventful for Case 1 for the first 11 years with normal continence, but she finally developed a repermeabilization of the accessory urethra leading to recurrent periclitoral abscess with urinary retention. After failure of local treatment of this "fistula", a continent urinary diversion according to Mitrofanoff was done and solved the problem.
No complication occur for the other two cases.
CONCLUSIONS
These reports demonstrate that late complications can occur with this rare condition of urethral duplication in girls and show that prolonged follow-up is necessary.
15:29 - 15:33
S02-12 (CP)
Jonathan AICHNER 1, Philipp SZAVAY 2, Tobias JHALA 3 and Sabine ZUNDEL 3
1) Kantonsspital Luzern, Children surgery, Luzern, SWITZERLAND - 2) Department of Pediatric Surgery, Lucerne, Lucerne, SWITZERLAND - 3) Department of Pediatric Surgery, Lucerne, SWITZERLAND
PURPOSE
Prenatal bladder ruptures are rare, therefore guidelines do not exist. We present a systematic literature review and case of a drug associated bladder rupture.
MATERIAL AND METHODS
Case: Fetal ascites was diagnosed at gestational week (GW) 31st in a male fetus. C-section was performed at GW 32 due to fetal abdominal compartment syndrome. After abdominal drainage, bladder decompression and resuscitation, a dorsal bladder defect was surgically closed.
Methods: A systemic literature review was conducted on "Embase", "PubMed" and "Science direct". Search terms included "prenatal/fetal bladder rupture", "prenatal/fetal urinary ascites" and "bladder rupture and opioid". 1765 publications were screened. After application of predefined exclusion criteria 26 cases were reviewed in detail.
RESULTS
Results: Posterior urethral valves (38%) and anterior urethral valves (12%) were the most common causes of spontaneous prenatal bladder rupture. Drug associated prenatal bladder rupture was found in 12% (opioids/benzodiazepine) . No underlying pathology was detected in 27%. Treatment concepts varied. Initial therapy consisted of bladder decompression (84%). Transurethral catheters (69%) or suprapubic catheters (15%) were being used. Conservative treatment (38%) with continuous bladder drainage, or surgical closure of the bladder defect (58%) depend on postnatal radiologic findings, clinical appearance and bladder extravasation.
CONCLUSIONS
Conclusion: Urethral valves are the most common cause of prenatal spontaneous bladder perforation. Drug associated bladder perforation has been previously described. Treatment concepts vary. Surgical bladder-closure, as done in our case was performed in over 50%. Decision making depends on radiologic findings, clinical appearance and bladder extravasation.
15:33 - 15:37
S02-13 (CP)
Carla RAMIREZ-AMOROS 1, Karla ESTEFANIA 1, Lucas MORATILLA 1, Maria SAN BASILIO 2, Francisco De Borja NAVA 2, Virginia AMESTY 2, Susana RIVAS 2, Roberto LOBATO 2, Pedro LOPEZ PEREIRA 2 and Maria Jose MARTINEZ URRUTIA 2
1) La Paz University Hospital, Paediatric surgery, Madrid, SPAIN - 2) La Paz University Hospital, Paediatric urology, Madrid, SPAIN
PURPOSE
Bladder duplication is a rare congenital malformation, with less than 75 reported cases, that is often associated to other congenital anomalies. Our purpose is to report a case of bladder duplication associated to urogenital sinus.
MATERIAL AND METHODS
We report a case of bladder duplication associated to urogenital sinus, amongst other congenital gastrointestinal and urinary anomalies, treated at our institution in 2021.
RESULTS
We present a female patient diagnosed with a persistent urogenital sinus with duplication of the bladder in the sagittal plane after a neonatal urinary tract infection. Cystoscopy, vaginoscopy and CT imaging supported the presence of an incomplete bladder duplicity in the sagittal plane, with an obstructed vagina entering the posterior wall of the left bladder. Surgical repair was made via Phannestiel incision and perineal approach. Both bladders were joined, the ureter of the only functioning kidney reimplanted and the common channel was left as the urethra. The vagina was separated from the posterior aspect of the left bladder and descended with a vaginoplasty with an intestinal segment. Among other congenital anomalies, the patient also presented an anterior anus, that required a posterior mobilization. She also presented left kidney atrophy and pubis diastasis. The patient is currently 2 years old with good sphincter control.
CONCLUSIONS
Given the low incidence of bladder duplications and the heterogeneity of its presentation, with many possible anatomies and clinical manifestations, each case must be studied and treated individually.
15:37 - 15:41
S02-14 (CP)
Faisal ALMUTAIRI 1, Gavin RITCHIE 2, Louise O'CONNOR 2 and Anju GOYAL 1
1) Royal Manchester children's Hospital, Paediatric Urology, Manchester, UNITED KINGDOM - 2) Royal Manchester Children's Hospital, Paediatrics, Manchester, UNITED KINGDOM
PURPOSE
Common causes of vaginal/perineal bleeding in prepubertal girls include trauma, tumour, foreign body, sexual abuse or urethral prolapse. If there is no obvious external finding, a cystovaginoscopy is done to evaluate. Authors report a case of female infant who presented with vaginal discharge and bleeding and was found to have gonorrhoea.
CASE
A 15 month- girl who was brought by her parents to Emergency Room with 2 days history of vaginal discharge and bleeding. There were no associated systemic symptoms. She had no history of trauma. A forensic examination was performed by a specialist and no signs of trauma to perineum were seen, hymen was intact. Routine vaginal swabs were taken. To rule out vaginal malignancy such as rhabdomyosarcoma, an US scan of abdomen and pelvis was done.
RESULTS
US showed hyperaemic uterus containing heterogenous and echogenic abnormality. MRI scan was done to evaluate further, and showed thickened uterine lining with clot in uterine cavity. Vaginal swab results showed Neisseria Gonorrhoea. Parents disclosed having irritation when passing urine themselves, that started 5 days earlier than their daughter's symptoms, and both were tested and confirmed to have Gonorrhoea. The child completed intravenous and oral antibiotics course for 2 weeks and recovered well. A repeated US scan after a week of treatment showed improvement in ultrasonic findings.
CONCLUSIONS
We report a case of vaginal bleeding due to gonorrhoea. Gonorrhoea in pre-pubertal children has been related mostly to sexual contact/ abuse while neonatal infection is transmitted from maternal infection during childbirth. However, direct contact with infected carer such as shared use of towels or bath may cause non-sexual transmission of gonococcal bacteria. Unusual infections should be suspected and screened for in case of vaginal bleeding.