Fetal ascites in cloacal malformations-a red flag.

INTRODUCTION: Cloacal malformation is a rare anomaly that remains a diagnostic challenge prenatally, despite the current advances in ultrasonography and MRI. This condition can in some, present with isolated ascites or with other findings, such as a pelvic cyst or upper urinary tract dilatation. In a minority, the ascites may be progressive, questioning the role of antenatal intervention. METHODS: We report on ten patients that have been identified from our Cloaca database between 2010 and 2022. RESULTS: The presence of ascites was associated with extensive bowel adhesions and matting, leading to a challenging initial laparotomy and peri-operative course. CONCLUSIONS: Antenatal finding of ascites in newborns with cloacal malformations should raise a red flag. The surgeon and anaesthetist should be prepared for the operative difficulties secondary to bowel adhesions and the higher risk of haemodynamic instability at the initial surgery. An experienced team at initial laparotomy in such patients is vital. LEVEL OF EVIDENCE: II.

Robot-assisted reconstructive surgery of lower urinary tract in children: a narrative review on technical aspects and current literature.

Background and Objective: Robotic approach is used widely for paediatric upper tract urinary reconstruction. This is a narrative review looking at the current status of robotic approach in lower urinary tract reconstruction. The aim of this article is to highlight the important technical aspects of commonly performed robotic lower urinary tract reconstructive surgeries and review the current literature. Methods: MEDLINE database search was conducted using MeSH terms and Boolean operators from Jan 2000 to Jun 2022. Abstracts were screened to exclude those in languages other than English as also articles pertaining to (I) upper urinary tract surgery, (II) only laparoscopic surgery (not robot-assisted) and (III) non-urological topics. Selected articles were then reviewed and search expanded to include their references with a focus on advanced lower urinary tract reconstruction. Key Content and Findings: The technical aspects of robotic ureteric reimplantation, continent catheterisable channel and autoaugmentation are discussed in detail. The early outcomes are comparable to open surgery. The true advantage of robotic approach becomes apparent when performing lower urinary tract reconstruction, where space in the pelvis is limited and access is challenging. Only a few centres are currently performing bladder neck surgery and bladder augmentation. Conclusions: Robotic lower urinary tract reconstruction in children is feasible and safe. Robotic approach offers better access, especially in the limited space within the pelvis. It reduces blood loss and post-operative pain allowing early recovery and discharge. Long-term follow-up with increasing experience could further validate these early observations.

Dual Pathology Causing Congenital Bladder Outlet Obstruction.

Anterior urethral syringocele is an uncommon congenital deformity characterized by cystic dilatation of bulbourethral gland ducts and is usually asymptomatic. We present a case on 4-day-old male neonate who presented with bilateral antenatal hydroureteronephrosis and renal impairment and found to have urethral syringocele and posterior urethral valves.

Cystoscopic injection sclerotherapy for bladder venous malformations.

Vascular malformations of the urinary bladder are rare in children and their management can be challenging. This minimally invasive approach was first described by the authors in lead 2013 and demonstrated that cystoscopic injections were safe without breech into the peritoneal cavity [1]. Cystoscopic injection sclerotherapy can be very successful in managing the complications of bladder vascular malformations and thereby avoiding extensive surgery. This VideoBank article demonstrates the technique of cystoscopic sclerotherapy for the management of bladder venous malformations.

A Rare Case of Complete Penile Agenesis.

Aphallia, or penile agenesis, is rare (1:30 million)1 and associated with other urogenital anomalies.2 Under 100 cases of aphallia have been reported worldwide.1 Pathogenesis is uncertain but thought to be failure of formation of the genital tubercle.2 We present a case of complete penile agenesis with anorectal and urological malformations.

Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis.

Conventionally, xanthogranulomatous pyelonephritis is treated with antibiotics and drainage of abscess followed by nephrectomy for definitive treatment. Surgical excision of the affected kidney carries risk of significant complications. An alternative treatment modality is described in the form of embolization of the renal artery to devascularise the renal parenchyma and ablate the renal tissue, thus avoiding a major surgical procedure and the significant risks involved.

Video presentation of the second stage of a two-stage repair for proximal hypospadias: a safe and reproducible technique.

OBJECTIVE: The aims of proximal hypospadias repair are good cosmetic outcomes with low rates of complication, with a low number of operative exposures, before the age of genital difference realisation. Neo-urethral fistula and stenosis are well recognised complications; with international rates of 3.8-16% and 1.3-15.6% respectively. We present the key steps of the second of a two staged repair in video format. METHOD: Video recording of the procedure performed on an 18-month-old with mid-penile hypospadias is presented. The steps are described; the importance of tension free tubularisation, layered urethral closure, suture technique, vascularised prepucal graft technique, optimal glanuloplasty, and penile shaft skin repair are highlighted. RESULT: The child was brought back to the day ward for catheter removal at 7 days; follow-up in clinic showed good postoperative appearance. This technique has been performed on 31 boys with a fistula rate and stenosis rate favourable to the literature. CONCLUSION: We demonstrate a two-stage technique by video format for proximal hypospadias which is reproducible and gives results comparable to the literature.

A rare presentation of a transethmoidal encephalocele at birth.

Transethmoidal encephalocele is a very rare condition. Herein, we report the case of a neonate with a transethmoidal encephalocele, who presented with an externally visible intranasal mass at birth. Clinical suspicion of intracranial extension was confirmed by radiological imaging. A bifrontal craniotomy was done to divide the narrow communicating duct. The mass was delivered through the nostril and duraplasty was completed. The postoperative recovery was uneventful.

Paediatric abdominal wall hernia following handlebar injury: should we diagnose more and operate less?

Traumatic abdominal wall hernia following handlebar injury can be easily missed and is thus underreported. A 12-year-old boy presented with handlebar injury to the left upper quadrant of his abdomen. Except for a localised swelling, thought to be related to a haematoma, he was haemodynamically stable. CT revealed an abdominal wall defect with herniating fat that was not evident clinically and was also missed on immediate ultrasound examination. As there were no associated injuries and the abdominal wall defect was small without any herniating bowel loops, masterly inactivity was observed. After 6 weeks, the swelling has disappeared completely and there is progressive reduction in the size of the defect.

Splenic torsion in a child with polysplenia and situs inversus: a very rare presentation.

Polysplenia with situs inversus along with the torsion of spleen is a rare event. We report a case of a 12 year old child who presented with acute abdominal pain. There was an ill-defined mass in right hypochondrium and lumbar regions. The CT scan of abdomen revealed presence of multiple spleens with infarction of the largest spleen and features of complete dextroversion. Intraoperatively the infarcted spleen was found twisted around its vascular pedicle and removed.

Xanthogranulomatous pyelonephritis in early infancy.

Xanthogranulomatous pyelonephritis is a severe, atypical form of chronic renal parenchymal infection, which mimics neoplasia and other inflammatory renal parenchymal diseases. Although xanthogranulomatous pyelonephritis has characteristic findings on sonography and CT scan, a clinical diagnosis is seldom possible. Correct diagnosis is made on exploration, by the presence of dense adhesions to the surrounding tissue and presence of pus in the kidney, which is confirmed histopathologically by the presence of lipid laden foamy macrophages, accompanied by both chronic and acute phase inflammatory cells.