Nonparasitic splenic cysts in children: a multicentric study.

PURPOSE: Nonparasitic splenic cysts (NPSCs) are uncommon in children. The aim of this multinational and multicentric study was to present the authors' experience as well as the changing trends in the management of NPSCs over the last 25 years. MATERIAL AND METHODS: From 1981 to 2005, 50 children or adolescents were surgically treated for NPSCs in 6 paediatric surgical centres in four European countries. The medical records of these 50 patients with NPSCs were reviewed retrospectively. RESULTS: Twenty-six male and 24 female patients were operated on. Age at surgery ranged from 1 to 17 years (mean 11.9). Seventeen patients were symptomatic. Six total (4 open and 2 laparoscopic) and 26 partial (22 open and 4 laparoscopic) splenectomies were performed. Laparoscopic fenestration or deroofing and open cystectomy was carried out in 9 patients, respectively. Histological findings revealed the lesion to be an epidermoid cyst (n = 28), a pseudocyst (n = 15) or a mesothelial cyst (n = 2). In 5 patients haemangioma or lymphangioma was the pathological diagnosis. At a mean follow-up of 2.9 years, residual cysts were found in 8 laparoscopically treated patients, 4 of whom required re-do laparoscopy or open surgery. CONCLUSIONS: Over the last two decades, the surgical treatment of NPSCs has changed from a formerly customary total splenectomy to spleen-conserving procedures, such as total cystectomy with or without partial splenectomy or partial cystectomy. These therapeutic modalities can be performed laparoscopically, if technically possible. Fenestration or deroofing of the cyst resulted in a high recurrence rate (7/9).

[The role and value of urodynamics in the follow-up of children with surgical bladder augmentation and substitution]. / Az urodinámia helye és értéke gyermekekben végzett húgyhólyag-megnagyobbítás és -pótlás nyomon követésében.

The authors investigated postoperative capacity, compliance of the urinary bladder and urinary continence in children who underwent bladder augmentation and/or bladder substitution for various forms of urinary incontinence. In 20 children, bladder augmentation and/or bladder substitution procedures were performed because of urinary incontinence, upper urinary tract deterioration and/or failure of conservative treatment (oxybutynin, clean intermittent catheterization--ICC). In 2 patients, reaugmentation was necessary. Urodynamic studies were performed on a regular basis, preoperatively and postoperatively. Based on their experiences, the authors conclude that recognition of changes in bladder capacity and/or compliance and especially the risk of developing upper urinary tract changes is only possible by performing urodynamic studies regularly. Urodynamics is also essential in decision making processes regarding redo surgeries (reaugmentation, transient or permanent urinary diversion).

[Urogenital sinus and cloacal malformations in infancy and childhood: surgical considerations]. / Sinus urogenitalis és cloaca malformatio gyermekkorban: sebészi szempontok.

The relative rarity of urogenital sinus and cloacal anomalies, the wide range of their anatomical variants furthermore the number of different surgical options makes the successful management of a child with such urogenital abnormality one of the greatest challenges to the paediatric surgeon. Based on their own experience and the literature the authors give a review of embryology, pathology, and diagnosis of urogenital sinus and cloacal abnormality. They detail the new surgical therapy developed by Hendren and Pena which has been adopted in their routine. This therapy has significantly improved the functional outcome and prognosis of these anomalies. Over the past 20 years 25 patients with urogenital sinus and cloacal abnormalities were surgically treated in the author's institute.

[Treatment of childhood vesicoureteral reflux with sub-ureteral injection of teflon paste]. / Gyermekkori vesicoureteralis reflux kezelése Teflon-paszta suburetericus injektálásával.

From March 1989 to october 1990, 35 refluxing ureters in 25 children were treated by submucosal injection of Teflon (STING). The overall success rate was 54% after the first injection. The authors detail the procedure and analyse their results which demonstrate that Teflon injection can be safe and effective treatment of vesicoureteral reflux in most cases can replace antireflux surgery.

[Continent urinary diversion in children: enterocystoplasty + appendiceo-cutaneostomy]. / Kontinens vizeleteltérítés gyermekkorban: enterocystoplasztika + appendico-cutaneostomia.

A continent urinary diversion was done by bladder augmentation using a cecal-colonic segment in total urinary incontinence in 3 patients aged 13, 16 and 21 years. The distal end of the appendix was brought to the skin. The narrow lumen of the appendix provides a closure mechanism in a low pressure urinary reservoir. A watertight, easily catheterizable urinary diversion might mean that there is no need to implant the distal end of the appendix into the bladder or colon in a submucous non-refluxing fashion as recommended by Mitrofanoff. The intermittent clean catheterization of the augmented bladder via the appendix was carried out at intervals of 3 hrs. 12-24 months after the establishment of urinary diversion the patients are free of complaints, socially fully accepted.

[Lacuna magna: diverticulum of the anterior urethra in childhood]. / Lacuna magna: Divertikel der vorderen Harnröhre im Kindesalter.

Three successfully treated cases of lacuna magna are presented. These small diverticula in the dorsal wall of the anterior urethra are often difficult to diagnose, despite the typical clinical signs (intermittent dysuria, hematuria and/or bloody spotting on underwear). Transmeatal excision of the valve-like leaflet (Guérin's valve) is a simple and effective form of treatment.