Bladder dysfunction in infants with primary vesicoureteric reflux.

There is growing evidence that bladder dysfunction is a negative prognostic factor for spontaneous resolution of vesicoureteric reflux (VUR). This study evaluated the prevalence of urodynamic abnormalities in infants with primary VUR who were referred over a 4-year period. The urodynamic evaluations and medical records of 54 infants with primary VUR (79 ureters with reflux) were reviewed prospectively. Urodynamic dysfunction was observed in 46.3% (n = 25) of infants with primary VUR; 35.2% (n = 19) had a low bladder capacity and 11.1% (n = 6) had a large bladder capacity. All infants with large bladder capacities also had high grade (IV - V) VUR. In conclusion, there was a close relationship between bladder dysfunction and primary VUR. For that reason, urodynamic testing of infants with primary VUR should be performed as part of routine clinical evaluations.

Late presentation of Bochdalek hernia: clinical and radiological aspects.

Three infants with late presentation of Bochdalek hernia are presented. The presenting symptoms were cough, intermittent vomiting, dyspnea, and cyanosis. Initial diagnoses of isolated paravertebral mass and foreign material aspiration were made in two infants, based on plain chest x-ray findings and history of the patients. Further radiological investigations, such as contrast upper gastrointestinal series or enema, computerized tomography, and magnetic resonance imaging of the chest, suggested the diagnosis of Bochdalek hernia. The hernia was found on the left side in two patients and on the right side in one. At operation, the stomach, small intestine, and spleen were found as herniated organs in one patient, ascending colon in one, and all of the small intestine together with ascending colon in the other. A congenital diaphragmatic defect should be suspected in every child presenting with unusual respiratory or gastrointestinal symptoms and with abnormal chest x-ray findings. The radiological findings vary greatly from one case to another, and even in the same case at different times because of differences in herniated organs and intermittent spontaneous reduction. The possibility of congenital diaphragmatic hernia should be kept in mind to avoid a wrong diagnosis, undue delay in diagnosis, and inappropriate treatment.

Epidermolysis bullosa associated with pyloric, esophageal, and anal atresia: a case report.

The association of epidermolysis bullosa (EB) and pyloric atresia (PA) in newborns is rare but has been well described. It has been reported that in patients with EB, the esophageal, gastric, intestinal, and colonic mucosae are affected. The authors report a case of EB and PA associated with esophageal and anal atresia in a newborn. To our knowledge, these associations had not been reported in the English-language literature.

Isolate abdominal bronchogenic cyst: a case report.

Isolated abdominal bronchogenic cysts are rare abnormalities. They are usually asymptomatic unless secondarily infected or large enough to cause compression of other vital structures. The authors report on a 20-month-old girl who had an abdominal bronchogenic cyst and presented with a history of recurrent urinary tract infections. The evaluation and treatment of this patient is presented as well as a review of the ten previously reported cases. A literature review showed only four cases in the pediatric age group. Excision is recommended to establish diagnosis and alleviate any symptoms. Abdominal bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal masses.

Congenital megalourethra.

Megalourethra, a rare congenital disorder involving the anterior urethra, is subdivided into two types: Fusiform and scaphoid. Two cases of scaphoid type megalourethra are reported. The first patient, a 5-weeks-old infant diagnosed at birth as having the prune belly syndrome was admitted to the hospital with vomiting and failure to thrive. Intravenous pyelogram revealed marked dilatation of the left ureter and a bladder diverticulum. A penile urethrostomy was performed. The second patient, born to healthy parents after an uneventful pregnancy and delivery, was found to have an enlarged and deformed penis. The baby voided with a poor stream and a concomitant swelling of the penis was noted. Retrograde uretrography showed a sac-like dilatation of the penile urethra. Surgical revision was carried out a 2 stage procedure and was completed (Nesbitt's operation) after 4 months. The patient did well postoperatively and voided with a normal stream without any abnormality of the penile shaft.

Proteus syndrome: clinical and surgical aspects.

The authors report a new case of Proteus syndrome with delayed diagnosis and they discuss the place of surgery in this syndrome.

An alternative approach to bladder autoaugmentation.

This article describes in detail the alternative technique of bladder autoaugmentation. The authors applied a different autoaugmentation method to reliably create a diffuse circular bulge or diverticulum by incising detrusor muscle while leaving bladder mucosa intact. The results were assessed by urodynamic, radiological, and histopathological methods.