Bilateral ureteric obstruction secondary to renal papillary necrosis.

A 2-year-old male presented to hospital with a 5-day history of vomiting and pyrexia. He was initially treated with non-steroidal medication as an anti-pyretic. Initial investigations demonstrated a raised urea and creatinine and he was treated with intravenous fluids. Within 24 h he became anuric with progressive renal insufficiency. Ultrasound scan demonstrated minimal bilateral hydronephrosis with debris in the lower pole calyces. The bladder was empty. Cystoscopy and retrograde contrast imaging revealed bilateral ureteric obstruction. Double J stents were inserted and his renal function returned to normal within 4 days. We believe the aetiology to be renal papillary necrosis and bilateral ureteric obstruction secondary to the administration of ibuprofen in association with dehydration.

Laparoscopic surgery for varicoceles in children: an audit in a single centre.

BACKGROUND: Varicoceles are associated with a time dependent decline in testicular function. The pathophysiology and timing of this remains unclear. However surgery for adolescent varicoceles is a relatively common procedure. There are several treatment options for this condition and in 1999 laparoscopic management was commenced at our institute. We performed an audit to compare our results with those reported in the literature. METHODS: A retrospective case-note review of patients identified from our theater database was performed. We reviewed patient demographics, indications, technique used, grade of surgeon, and outcomes. A review of the literature was carried out to identify a gold standard to compare our results with. RESULTS: Between 1999-2007 we operated on 24 adolescent varicoceles, all left side. Median age was 13.5 years (range 8-16). Indications for surgery included high grade varicocele, discomfort and testicular atrophy. All patients underwent laparoscopic Palomo technique dividing all vessels and lymphatics. The grade of primary operator was consultant (54%) and trainee (46%). Complications included wound infection (4.1%), hydrocele (12.5%), and recurrence (8.3%). We found no consensus view regarding the management of varicoceles in adolescents within the literature; however, our outcomes compared favorably with other published results using the laparoscopic Palomo technique. CONCLUSIONS: Laparoscopic management of varicoceles is safe and effective at our institute. The indications and timing of surgery remain varied. The surgery is performed by both consultants and trainees.