RESUMO
BACKGROUND AND PURPOSE: Pediatric patients with urolithiasis and complex reconstructed genitourinary anatomy pose a significant surgical challenge. We describe a technique utilized to treat an obstructing calculus in the ectopic kidney of a patient with a history of cloacal exstrophy, bladder augmentation, Monti catheterizable channel, and reconstructed abdominal wall. Case and Technique: A 5-year-old female with a history of cloacal exstrophy, pelvic kidney, and reconstructed urologic and abdominal wall anatomy presented after prior shockwave lithotripsy with an obstructing ureteropelvic junction calculus with signs of sepsis. Because of the patient's previous abdominal wall reconstruction with polytetrafluoroethylene mesh and the location of her pelvic kidney, traditional methods of percutaneous nephrostomy tube placement could not be performed. Transgluteal percutaneous nephrostomy tube was placed by interventional radiology. Subsequently, a percutaneous nephrolithotomy (PCNL) was performed through this tract. CONCLUSIONS: Transgluteal PCNL is a feasible option in children with complex congenital genitourinary anomalies with a history of reconstructed anatomy.
Assuntos
Cálculos Renais/cirurgia , Pelve Renal/cirurgia , Rim/cirurgia , Nefrostomia Percutânea/métodos , Ultrassonografia de Intervenção , Cálculos Ureterais/cirurgia , Obstrução Ureteral/cirurgia , Parede Abdominal/cirurgia , Extrofia Vesical/complicações , Extrofia Vesical/cirurgia , Pré-Escolar , Feminino , Hérnia Umbilical/complicações , Hérnia Umbilical/cirurgia , Humanos , Ileostomia , Rim/anormalidades , Cálculos Renais/complicações , Cálculos Renais/diagnóstico por imagem , Pelve Renal/diagnóstico por imagem , Litotripsia , Cirurgia Assistida por Computador , Cálculos Ureterais/complicações , Obstrução Ureteral/complicações , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/cirurgia , Procedimentos Cirúrgicos UrológicosRESUMO
Vesicoscopic ureteral reimplantation is a challenging procedure to learn but does have outcomes equivalent to standard open repair. Children objectively have less pain than after an open cross-trigonal repair. Operative times compare favorably to other forms of minimally invasive surgery.
Assuntos
Laparoscopia/métodos , Reimplante/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Refluxo Vesicoureteral/cirurgia , Criança , Pré-Escolar , Cistoscopia/métodos , Feminino , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/fisiopatologia , Resultado do Tratamento , Refluxo Vesicoureteral/diagnósticoRESUMO
Epidermal inclusion cysts are benign lesions that can be found in many parts of the body. They are rarely seen in the clitoral region in pediatric patients but when these are found, they are most commonly seen with a history of trauma. We report an uncommon case of a spontaneous nontraumatic epidermal inclusion cyst in the clitoral hood of a female child. This presentation mimicked clitoromegaly but was ultimately found to be a large epidermal cyst that was successfully excised surgically. We present the important pathologic findings and review the relevant literature.