ESPU Meeting on Wednesday 17, April 2024, 14:45 - 15:55
14:45 - 14:49
S02-1 (CP)
Mohamed HUSSINY, Mohamed DAWABA, Tamer HELMY and Ashraf T. HAFEZ
Urology and Nephrology center - Mansoura University, Urology department, Mansoura, EGYPT
PURPOSE
Renal isotope scan is considered the most accurate method for diagnosis of a nonfunctioning kidney radiologically. To the best of our knowledge, there is no data regarding outcome of pyeloplasty for congenital ureteropelvic junction obstruction (UPJO) in a nonfunctioning kidney. We present the outcome of pyeloplasty in 3 selected male infants born with antenatal hydronephrosis and had no perfusion of the affected renal units on preoperative nuclear renal scan.
MATERIAL AND METHODS
Basal preoperative renal ultrasound and renal isotope scan were done. All three cases were treated with pyeloplasty based on the favorable gross appearance of the renal parenchyma and the tense dilated extra-renal pelvis on surgical exploration as well as the young patient’s age. Open stented Anderson-Hynes pyeloplasty was done in all three cases. Post-operative renal ultrasound and renal isotope scan were repeated for each case.
RESULTS
The diagnosis was right UPJO in one case and left in 2 cases. One infant underwent pyeloplasty at age of 11 months while the other 2 cases at age of 3 months. Post-operative ultrasound was improved regarding Anteroposterior Diameter of renal pelvis and renal Parenchymal Thickness. Post-operative renogram demonstrated recoverability of renal function in the affected renal units. Post operative renogram revealed differential renal function of 29.2%, 43.7% and 31%. The tense dilated renal pelvis (intra-pelvic pressure) may compromise the blood supply to the kidney (arterial pressure) causing the preoperative picture of non-perfused kidney by radioisotope scan.
CONCLUSIONS
Radioisotope renography may be inaccurate in the prediction of renal function in infants with extreme hydronephrosis due to UPJO. In infants with UPJO and zero functioning kidney by radioisotope scan, the decision of pyeloplasty must be considered based on the favorable appearance of the renal parenchyma rather than preoperative radiology.
14:49 - 14:53
S02-2 (CP)
Michael CHIEN 1, Emily FISHER 1, Logan HUBBARD 1, Nabeel SHAKIR 1 and Yegappan LAKSHMANAN 2
1) Henry Ford Health, Vattikuti Urology Institute, Detroit, USA - 2) Children's Hospital of Michigan, Department of Pediatric Urology, Detroit, USA
PURPOSE
Penile skin deficiency, as in failed hypospadias repairs and recurrent lichen sclerosus, often present a challenge due to limited durable treatment options. Native tissue grafts possess limitations, such as in lichen sclerosus, where local tissue transfer may not be advisable. Acell Cytal Matrix is a porcine-derived extracellular tissue that facilitates remodeling of local tissue to support a healing environment. We describe our initial experience using Acell Cytal in patients requiring complex skin defect coverage and penile resurfacing.
MATERIAL AND METHODS
We describe the technique and present our initial experience with Acell Cytal as a penile resurfacing matrix for treatment of ventral chordee, Balanitis Xerotica Obliterans (BXO), recurrent lichen sclerosus, and phallic wound dehiscence after penoplasty in both pediatric and adult patients.
RESULTS
Acell Cytal was used as a successful substitute to autologous skin grafts in five patients presenting with poor wound healing as seen on serial post operative photographic follow-up. Good functional and cosmetic outcomes were subjectively reported amongst patients at a median follow up of 14 months.
CONCLUSIONS
Failed hypospadias repairs, Lichen sclerosus, and/or re-operative penile surgery often present unique challenges for the reconstructive urologist. This represents our preliminary series utilizing novel exogenous grafting material for complex penile resurfacing. This grafting technique augments the current reconstructive armamentarium as we were able to demonstrate that Acell Cytal grafts are safe, well tolerated, and able to cover considerable sized defects with acceptable immediate and intermediate-term aesthetic outcomes.
14:53 - 14:57
S02-3 (CP)
Mehmet Ugur YILMAZ 1 and Tubanur BALTA SARI 2
1) Diyarbakir Children's Hospital, Paediatric Urology, Diyarbakir, TURKEY - 2) Gazi Yasargil Training and Research Hospital, Underwater and Hyperbaric Medicine, Diyarbakir, TURKEY
PURPOSE
We aimed to present the hyperbaric oxygen therapy(HBOT) results of five patients who were operated for distal hypospadias and developed glans ischemia.
MATERIAL AND METHODS
Five patients who received HBOT after hypospadias surgery between October 2022 and April 2023 were included in this study. HBOT protocol was carried out in 2.4 ATA(atmosphere absolute)/45 fsw(feet sea water) and treatment time was 120 minutes. The number of sessions were determined individually for each patient. Before and after therapy penile shaft and glans of the patients were photographed.
| Patients | Age(years old) | Diagnosis | Surgical Method | HBOT Initiation Date(Postoperative) | Number of HBOT Sessions Received | Additional Intervention |
| 1 | 10 | Coronal Hypospadias | TIP(Tubularized Incised Plate) Repair | 7th Day | 14 | One Session of Urethral Bougie Dilation |
| 2 | 1 | Coronal Hypospadias | MAGPI(Meatal Advancement and Glanuloplasty ) | 1st Day | 9 | |
| 3 | 3 | MIP(Megameatus and Intact Preputium) | Duplay | 4th Day | 5 | Two Sessions of Urethral Bougie Dilation |
| 4 | 3 | MIP | Duplay | 1st Day | 9 | |
| 5 | 2.5 | Glanular Hypospadias and Concealed Penis | MAGPI and Concealed Penis Corrrection | 1st Day | 6 |
RESULTS
Patients who developed glans ischemia were treated for the formation of necrosis demarcation line and to support wound healing. It was observed that the ischemic status improved in all patients from the first session of treatment. All patients were discharged when the wound epithelisation started after the ischemia line was demarked. Wound healing was better in patients with early detection of glans ischemia and whose sessions were started more quickly. Urethral strictures requiring urethral dilation developed in patients who started their sessions later than others.
CONCLUSIONS
We believe that HBOT treatment in the early period is important to prevent progression to necrosis and reduces early and late complications in cases of postoperative glans ischemia after hypospadias surgeries.
14:57 - 15:01
S02-4 (CP)
Melis CEVHERTAS, Omer Bariş YUCEL, Sumeyye SOZDUYAR, Sibel TIRYAKI, Ali TEKIN and Ibrahim ULMAN
EGE UNIVERSITY FACULTY OF MEDICINE, PEDIATRIC SURGERY, Izmir, TURKEY
PURPOSE
The use of the vermiform appendix as a replacement for ureteral segments has been rarely reported, especially in children and on the left side. This study presents a case where the appendix was successfully used to bridge a ureteral stricture in a child.
MATERIAL AND METHODS
A 6-year-old male presented with hematuria and a stone at six months of age. After laser lithotripsy via ureterorenoscopy, hydronephrosis was observed two months later. Despite prophylactic antibiotics, the patient had recurrent urinary tract infections. Retrograde pyelogram revealed a 4 cm stenosis in the left midureter above the iliac cross. The mesoappendix allowed the appendix to be used for interposition on the left ureter.
RESULTS
The patient was followed with a JJ stent for two months. Ureterorenoscopy during JJ removal showed no stricture.Three years after the surgery, imaging showed improved hydronephrosis, stable function, and no obstructive findings on the MAG3 scan.
CONCLUSIONS
Children undergoing stone surgery should be monitored for potential complications, including strictures. Appendiceal interposition should be considered as a viable treatment option for ureteric injuries, even for the left ureter.
15:01 - 15:05
S02-5 (CP)
Maria ESCOLINO 1, Paolo CAIONE 2, Mariapina CERULO 1, Fulvia DEL CONTE 1, Benedetta LEPORE 1, Annalisa CHIODI 1, Claudia DI MENTO 1 and Ciro ESPOSITO 1
1) Federico II University Hospital, Pediatric Surgery, Naples, ITALY - 2) Salvator Mundi International Hospital, Pediatric Urology, Rome, ITALY
PURPOSE
Urethral duplications are rare lower urinary tract anomalies, with several anatomical variants. We describe unusual presentation of complete hypoplastic type 2A-2 urethral duplication according to Effmann with bilateral obstructive megaureter and prolonged bladder outlet obstruction, which was managed through Progressive Augmentation by Dilating the Urethra Anterior (PADUA).
MATERIAL AND METHODS
A 2-year-old boy, with prenatal diagnosis of bilateral hydronephrosis, was referred to our institution for recurrent febrile urinary tract infections (UTIs). Physical examination revealed double urethral meatus, one orthotopic and one hypospadic. Pre-operative imaging showed bilateral obstructive megaureter with paraureteral diverticula and thickened bladder wall. Cystourethroscopy showed hypoplastic ventral penile urethra and semi-atretic dorsal urethra ending on the glans tip. The two urethras ended in a single obstructed bladder opening. Dilation of the bladder neck and catheterization of both urethras were performed. VCUG confirmed the diagnosis of type 2A-2 urethral duplication according to Effmann. Ureteral reimplantation and bladder neck plasty were performed. Postoperatively, the patient developed prolonged bladder retention, managed with progressive augmentation by dilating the ventral hypospadic urethra.
RESULTS
Spontaneous voiding was obtained after 6 months. Post-operative VCUG showed normal capacity bladder, with regular walls and no diverticula, and normal profile of the ventral urethra at voiding. To date, the child is asymptomatic, voiding through the hypospadic meatus with dry intervals, and with the orthotopic meatus functionally obliterated. The hypospadias repair has been postponed.
CONCLUSIONS
The subtype 2A-2 urethral duplication may be complicated by prolonged urinary obstruction. PADUA technique was effective to improve urethral caliber and function recovery.
15:05 - 15:09
S02-6 (CP)
Neetu KUMAR and Abraham CHERIAN
Great Ormond Street Hospital, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
Urogenital manifestations of Crohn's disease are rare. We present a case series of children with genital oedema as the only sign of granulomatous disease without any gastrointestinal symptoms.
MATERIAL AND METHODS
We retrospectively reviewed consecutive children presenting with chronic (>6-months) genital oedema between the years 2013-2019. These children met a variety of clinicians including General Practitioner, Emergency, Paediatrician, Dermatologist, adult Urologist and Gynaecologist. A wide array of investigations was reviewed including soft tissue ultrasound, MRI, upper and lower GI endoscopic biopsy, genital skin biopsy, specific haematological and faecal tests such as calprotectin.
RESULTS
Five children (1F, 4M), mean age of onset 11 years (range 8-14 years) with chronic genital oedema were included. None had any gastrointestinal symptoms. Penile and/or scrotal oedema was noted in boys with clitoral hood oedema in the girl. Genital skin biopsy in all demonstrated the presence of characteristic non-caseating granulomata. Other investigations including gastrointestinal biopsies were normal. Treatment with biologic immunomodulators was offered in 4 patients with good resolution of oedema.
CONCLUSIONS
Genital oedema could be the first and only presenting feature of Crohn's disease. Skin biopsies may be required for diagnosis. This case series alerts urologists to the existence of this entity and stresses the need to have a targeted investigative pathway and collaboration with Gastro-enterology for early confirmation and treatment.
15:09 - 15:13
S02-7 (CP)
Tharanga GAMAGE and Abraham CHERIAN
Great Ormond Street Hospital for Children London, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
We present 2 boys with pneumaturia initially dismissed as being unlikely, but could indicate a benign or malignant pathology.
MATERIAL AND METHODS
Case 01
A 5-year-old was referred with a history of recurrent UTI and epididymo-orchitis over a two-year period. Parents described a whistling sound and passage of air towards the end of micturition.
Case 02
A 4-year-old presented with abdominal pain, initially treated for constipation. Subsequently malodourous urine and passage of air bubbles during micturition were reported.
RESULTS
Case 01
Contrast MRI revealed a colo-urethral fistula. Laparotomy revealed total colonic duplication with recto prostatic fistula from one colonic moiety. A bladder duplication was also noted.
Recto prostatic fistula was divided and ligated. Common wall of the colonic duplication was divided with endo GIA stapler. Bladder septum was divided and a covering ileostomy fashioned. SPC provided drainage for 3-months until spontaneous voiding was established. He had an uncomplicated recovery and has remained infection free for a year until now. Stoma reversal is awaited.
Case 02
MRI revealed a large central abdominal mass with air in the bladder and right hydro-ureteronephrosis. Biopsy and further imaging confirmed a high-grade atypical Burkitt's lymphoma with tumour-vesical fistula.
An ileostomy and right-sided nephrostomy was placed. There was a good response to chemotherapy and diversions were subsequently reversed.
He made an excellent recovery following bone marrow transplantation.
CONCLUSIONS
Pneumaturia although rare should be given due gravity and promptly investigated.
15:13 - 15:17
S02-8 (CP)
Sara Monserrat PROAÑO LANDÁZURI 1, Alicia GÓMEZ SÁNCHEZ 1, Daniel CABEZALÍ BARBANCHO 2, Cristina TORDABLE OJEDA 2 and Andrés GÓMEZ FRAILE 2
1) Hospital Universitario 12 de Octubre, Pediatric Surgery, Madrid, SPAIN - 2) Hospital Universitario 12 de Octubre, Pediatric Surgery, Urology section, Madrid, SPAIN
PURPOSE
Interposition of the gracilis muscle has a success rates of 70-90%, treating urinary complex fistula. We present two cases in which this flap was performed for the repair of urethral fistulization.
MATERIAL AND METHODS
Retrospectively reviewed data. In both cases, after repairing the fistula, we proceed to the disinsertion, dissection and proximal release of the gracilis muscle. Subsequently, the flap was rotated 180° and tunneled through the subcutaneous inguinal tissue, to be placed between the urinary tract and the rectum/vagina.
RESULTS
Patient 1: A 12-year-old girl with exstrophy of the cloaca and meningocele, with a colostomy since birth. At 8 years of age, reconstruction surgery was performed. Urinary incontinence due to urethral recanalization persists despite a second attempt to close the bladder neck. Finally, a new disconnection is successfully performed by interposing a flap of gracilis muscle between the neck suture and the vestibular suture.
Patient 2: A 12-year-old male with embryonic vesicoprostatic rhabdomyosarcoma treated with surgery, radiotherapy and brachytherapy during the first year of life, presenting urinary incontinence, anal stenosis and prostatic rectourethral fistula as sequelae. Definitively repaired by interposition of the gracilis muscle, performing rectal resection and anoplasty, enterocystoplasty, cervicourethral disconnection, bilateral ureteroneocystostomy and Mitrofanoff.
No intra- or postoperative complications were recorded, as well as no recurrence.
CONCLUSIONS
According to our experience, the interposition of the gracilis muscle is a safe technique that can be considered as a surgical resource for the treatment of complex urinary fistulas in pediatric patients.
15:17 - 15:21
S02-9 (CP)
Grzegorz KUDELA, Agnieszka WIERNIK, Magdalena JASTRZĘBSKA and Tomasz KOSZULSKI
Upper Silesian Children's Health Center - Medical University of Silesia, Paediatric Surgery and Urology, Katowice, POLAND
PURPOSE
Epidermolysis bullosa (EB) is a life-threatening disorder often impacting the urinary tract, resulting in urinary tract strictures, causing varying degrees of urine flow obstruction. Instrumental procedures on the urinary mucosa pose considerable risks, exacerbating symptoms and making efficient, safe bladder emptying a significant challenge. This study presents a successful case of treating severe urethral stenosis in an EB patient with the Macedo procedure and conducts a systematic review of alternative surgical approaches for EB-related urethral obstruction
MATERIAL AND METHODS
We comprehensively reviewed the medical records of an EB patient who underwent the Macedo procedure. We conducted extensive searches on PubMed, Web of Science, Embase, and Google Scholar, strictly adhering to PRISMA guidelines, to investigate urological surgeries in EB patients over the past decade.
RESULTS
The patient initially presented with nail dystrophy and recurrent complete pyloric atresia, followed by severe urethral narrowing, leading to a confirmed EB diagnosis. The patient underwent multiple urethral dilatations and a wide vesicostomy before receiving a Macedo reservoir. Although the follow-up period remains limited, initial outcomes are encouraging. Our systematic review revealed that most urological procedures for EB-related urethral obstruction, including dilation, meatoplasty, urethroplasty, and intraurethral stricture incisions, yielded unsatisfactory results, often necessitating permanent suprapubic catheters, vesicostomies, perineal urethrostomies, ileal-neo bladders with ileum pouches, or constantly catheterized Mitrofanoff appendicovesicostomies.
CONCLUSIONS
The Macedo procedure offers promise for creating a catheterizable bladder in EB patients, reducing urothelial irritation and mitigating the progression of EB-related lesions, ultimately improving the patients' quality of life.
15:21 - 15:25
S02-10 (CP)
Fırat ÖZERVARLI 1, Rifat Burak ERGÜL 1, Ismail SELVI 1, M.İrfan DÖNMEZ 1, Bilal ÇETIN 1, Tayfun OKTAR 1, Hikmet Gülşah TANYILDIZ 2, Sifa SAHIN 2, Ayça IRIBAŞ 3, Deniz YANIK 3 and Orhan ZIYLAN 1
1) Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey, Urology, Istanbul, TURKEY - 2) Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey, Pediatric Hematology-Oncology, Istanbul, TURKEY - 3) Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey, Radiation Oncology, Istanbul, TURKEY
PURPOSE
The treatment of two pediatric patients with bladder rhabdomyosarcoma(RMS) is presented.
MATERIAL AND METHODS
Case 1:A 3-year-old girl without any comorbidities presented with a complaint of difficulty urinating for six months. Computed tomography(CT) revealed bilateral grade 2 hydronephrosis and a 34x25 mm heterogeneous enhancing polypoid mass extending from the anterior bladder (Figure 1a).Immunohistochemical examination of the punch biopsy revealed botryoid rhabdomyosarcoma with strong positive myogenin and desmin, and negative smooth muscle actin.The patient received nine cycles of cyslofhosphamide chemotherapy.The bladder mass regressed upon imaging two months after chemotherapy(Figure 1b).The patient underwent partial cystectomy(Figure 1c, 1d).According to final pathology,the case was classified as stage 3 (T1N0M0) intermediate risk.Three sessions of brachytherapy were administered on the 10th postoperative day.At the end of 28 weeks, vincristine+actinomycin+cyclophosphamide(VAC) chemotherapy was administered.No evidence of residual mass was observed during a 6-month follow-up.
Case 2:A 8-month-old male patient without any comorbidities presented with the complaint of difficulty in urination.A 50 mm sized mass from the bladder base extending to the bladder neck was detected in CT(Figure 4).The punch biopsy revealed botryoid rhabdomyosarcoma.The patient underwent radical cystectomy and ileal loop.The final pathology was also confirmed as botryoid rhabdomyosarcoma.No recurrence or metastasis was observed in the five-year follow-up of the patient,who received 25 sessions of radiotherapy in addition to twelve cycles of neoadjuvant and 6 cycles of adjuvant chemotherapy(vincristine+cyclophosphamide).
RESULTS
CONCLUSIONS
Although genitourinary RMS is a rare genitourinary malignancy,it can be cured with a multidisciplinary approach including surgery,chemotherapy,and radiotherapy.
15:25 - 15:29
S02-11 (CP)
Karolina OSKROBA 1, Kinga KOWALCZYK 1, Piotr GASTOL 1 and Jedrzej SARNACKI 2
1) The Children's Memorial Health Institute, Paediatric Urology, Warsaw, POLAND - 2) The Children's Memorial Health Institute, Imaging Diagnostics, Warsaw, POLAND
PURPOSE
To evaluate the diagnostic pattern of the fast growing, large tumor located in the right inguinal canal. In MRI study the mass was described as lipocarcoma.
MATERIAL AND METHODS
We analyzed medical database. USG Doppler, MRI (iv contrast), surgery and pathology report were reviewed.
RESULTS
Doppler USG revealed a mass in the right inguinal canal and upper half of the scrotum. It was also visible in the subcutaneous tissue. The tumor (63x35x18mm) consisted of abnormal lipomal tissue. The echogenicity was higher than in any normal lipomal tissue. No blood circulation was visible. MRI (iv contrast) showed lipomal tumor (67x29x31mm) with thin septa that enhanced with contrast suggesting liposarcoma originated from testicular cord. Both testicules were described as normal. After oncology consultation the boy was operated. The tumor was removed via inguinal incision. The mass was well separated from the testicular cord. Macroscopically right testis and epididymis were normal. Spermatic cord and right testicle were preserved. There was a thick fiber tissue that connected the tumor with the right pubic ramus. The histo-pathology report revealed totally resected lipoma. Also genetic studies were done. In the 7 months of follow ups the patient had no recurrence.
CONCLUSIONS
1. Fast growing tumor suggests malignancy.
2. USG, MRI (iv contrast) oncology consultation are mandatory before operation.
3. The current treatment of choice is en bloc resection and histo-pathology examination.
15:29 - 15:33
S02-12 (CP)
Zong Jie KOH 1, Yi Ting LAI 2, Yang Yang LEE 3, Dale Lincoln LOH 3, Vidyadhar MALI 3 and Yoke Lin NYO 3
1) National University Hospital Singapore, Paediatric Surgery, Singapore, SINGAPORE - 2) National University Hospital Singapore, Department of Pathology, Singapore, SINGAPORE - 3) National University Hospital Singapore, Department of Paediatric Surgery, Singapore, SINGAPORE
PURPOSE
Malignancies occurring in reconstructed urinary systems using bowel are a well-known phenomenon. Its occurrence in mitrofanoff conduits are rarely described with few case reports of squamous differentiation. We present an unusual case of a patient with adenocarcinoma arising from his mitrofanoff.
MATERIAL AND METHODS
30YO gentleman with i) anorectal malformation, ii) tethered cord and iii) horseshoe kidney. At 5YO, he developed neurogenic bladder with obstructive uropathy resulting in renal failure. A mitrofanoff was created at 13YO to facilitate self-catheterisation. He underwent a living-donor renal transplant at 24YO which was complicated by repeated episodes of rejection requiring treatment. His regular immunosuppressants include tacrolimus, mycophenolate mofetil and prednisolone.
RESULTS
At 27YO he was noted to have a 7mm granulation tissue at the inferior margin of the mitrofanoff exit site. This was cauterized with silver nitrate. A year later, this had grown to 1.5cm and cauterization was performed again with little effect. Further management was delayed till 2 years later due to medical and social reasons. He underwent excision of the exuberant tissue, which had grown to 4x3cm and revision of the mitrofanoff. Histology revealed atypical glandular proliferation with high grade dysplasia and areas of adenocarcinoma with mucinous features. Repeat circumferential excision of the skin-mucousal junction was performed with mitrofanoffscopy and cystoscopy. There were no other lesions identified and histology was negative for malignancy. Cross-sectional imaging and colonic evaluation are under consideration due the possibility of a primary appendiceal neoplasm.
CONCLUSIONS
Adenocarcinomatous change can occur in mitrofanoff conduits. Attention should be paid to abnormal lesions especially in transplant patients.
15:33 - 15:37
S02-13 (CP)
Martin KAEFER
RILEY HOSPITAL FOR CHILDREN, PEDIATRIC UROLOGY, Indianapolis, USA
PURPOSE
Traumatic UPJ avulsion in a child is a rare event. We report a case of bilateral complete UPJ avulsion in a one-year-old female resulting from an unrestrained motor vehicle accident.
PATEINT AND MATERIALS
A one-year-old female presented to our emergency room following a motor vehicle accident. Abdominal CT scan revealed a partial tear of her aorta. She was taken to the operative suite by vascular surgery. Complete absence of urine output from the Foley catheter combined with bilateral expanding retroperitoneal fluid collections prompted consultation with pediatric urology. Exploration of the right perinephric space released clear fluid. Complete avulsion of the ureter was noted. Inspection of the renal hilum revealed intermittent spurts of urine from a pinpoint opening in the renal pelvis. The ureter was anastomosed to the pelvis with interrupted 7-0 polyglyconate sutures and stented with a 3.0 French double J catheter. Identical pathology was noted on the contralateral side and similarly repaired. Perinephric drains were removed on postoperative days 5 and 6 after demonstrating minimal output. Stents were removed sequentially at 6 and 8 weeks respectively.
RESUILTS
Annual renal ultrasounds demonstrate healthy kidneys with no hydronephrosis three years following the event.
CONCLUSIONS
Immediate repair of traumatic UPJ avulsion is feasible and recommended in a stable patient.
15:37 - 15:41
S02-14 (CP)
Sara Monserrat PROAÑO LANDÁZURI 1, Lara MERINO MATEO 1, Daniel CABEZALÍ BARBANCHO 2, Cristina TORDABLE OJEDA 2 and Andrés GÓMEZ FRAILE 2
1) Hospital Universitario 12 de Octubre, Pediatric Surgery, Madrid, SPAIN - 2) Hospital Universitario 12 de Octubre, Pediatric Surgery, Urology section, Madrid, SPAIN
PURPOSE
Renal traumatism is a cause of morbidity and mortality in the pediatric patient.
We present a case of renal traumatism grade IV, with complex injury of the renal parenchyma and collector system initially managed by laparoscopy.
MATERIAL AND METHODS
4-year-old girl with trauma on her left lumbar quadrant after falling of a slide, presenting with nausea, abdominal pain, hematuria and pallor, hemodynamically stable. An abdominopelvic CT, founded left renal rupture with avulsion of the pyeloureteral junction (PUJ), urinary leakage at the level of the pelvis and large left perirenal hematoma, surgical management was performed.
RESULTS
Due to the impossibility of placing a nephrostomy and a catheter by cystoscopy, an exploratory laparoscopy was performed, in which was found a complete fracture of the kidney in the middle third with almost complete avulsion of the PUJ. Two urinary diversion drains were placed facing the upper and lower calyxes, replaced by nephrotomies in a month, follow up by an double J uretheral catheter. An abdominal US performed, 4 months later, showed cortical scars, P2 grade renal and ureteral dilation. In the diuretic renogram, a size reduction of the kidney, with a slight deterioration of parenchymal function (RF 34.8%) and non-obstructive ureteral dilation, was founded. The patient remains asymptomatic.
CONCLUSIONS
High-grade renal traumatism management should be individualized, with a joint collaboration of Urologists and Interventional Radiologists.
We consider that in selected cases the laparoscopic approach has a role in the initial management of renal trauma.
15:41 - 15:45
S02-15 (CP)
Giuseppe CRETÌ 1, Diego PALLADINO 2, Antonio CRETÌ 3, Lorenzo CAPONE 4, Costanzo LATIANO 4, Nicola PALLADINO 4, Filomena URBANO 2 and Locatelli ANNA 5
1) Ospedale Casa Sollievo della Sofferenza IRCCS- San Giovanni Rotondo, Pediatric Urology, San Giovanni Rotondo, ITALY - 2) Ospedale Casa Sollievo della Sofferenza IRCCS- San Giovanni Rotondo, Radiology, San Giovanni Rotondo, ITALY - 3) Fondazione Universitaria Policlinico Agostino Gemelli, Urology, Roma, ITALY - 4) Ospedale Casa Sollievo della Sofferenza IRCCS- San Giovanni Rotondo, Urology, San Giovanni Rotondo, ITALY - 5) Ospedale Casa Sollievo della Sofferenza IRCCS- San Giovanni Rotondo, Pediatrics, San Giovanni Rotondo, ITALY
PURPOSE
Identifiying the right diagnostic and therapeutic approach in complex persistent urogenital sinus cases.
MATERIAL AND METHODS
Persistent urogenital sinus (PUGS), is a rare congenital malformation of the urogenital system. We report a "high joined" and complex PUGS case of a 3yrs old female from Morocco, in Italy on temporary visa and no fixed abode , presenting with recurrent fever and urinary tract infection, urinary incontinence , chronic renal insufficiency with oligoanuria, chronic constipation and abdominal ultrasound diagnosis of severe bilateral hydroureteronephrosis.
Failure of catheterization per uretram led to derivation with emergency epicistostomy. Diagnostic workup was set as following: Rx-epicistography showed bilateral megaureter (obstructing on the left and refluxing on the right) and a long atresic urethra . MAG 3 renography suggested important loss of renal function (mostly on the left side). Genitoscopy revealed a septate vagina with a didelphys cervix and unicornuate uterus.
RESULTS
Bilateral ureteral reimplantation according to Politano Leadbetter was then performed. In postoperative period minor anemization (2 blood units transfused) and paralytic ileus occurred. Patient was discharged in good condition with draining button cistostomy. Resolution of clinical symptoms and improvement in radiological scenario were evident (abdominal ultrasound follow up at 3 months showing reduction of bilateral hydroureteronephrosis, magnetic resonance of the abdomen with contrast at 6 months demonstrating absence of previous marked bladder hypertrophy ).
CONCLUSIONS
Reconstruction of a continent urinary derivation ( Mitrofanoff procedure ) was delayed only for the previously mentioned social issues.