Posterior urethral valves masquerading as neuropathic bladder following sacrococcygeal teratoma resection.

Neuropathic bladder may be a co-associated morbidity in newborn babies following resection of a sacrococcygeal teratoma. We report a case of a male newborn showing features of incomplete urinary voiding requiring intermittent catheterisation after operation for bladder emptying. Videourodynamic assessment excluded neuropathic bladder and posterior urethral valves were demonstrated on micturating cystography. Urology outcomes have been excellent following curative valve ablation. This report highlights the crucial importance of being aware of the rare coexistence of lower urinary tract pathology in male babies with sacrococcygeal teratoma. Routine urodynamic assessment should be considered in all children following sacrococcygeal teratoma resection.

Complications of inguinal herniotomy are comparable in term and premature infants.

PURPOSE: Inguinal hernias are common, and prevalence is highest in premature males. Recognised complications include recurrence, iatrogenic cryptorchidism and testicular atrophy. We reviewed complication rates following inguinal herniotomy (IH), comparing premature (gestation <36 weeks) and term infants. METHODS: A retrospective case note review of infants aged 0-12 months undergoing IH between January 2006 and December 2010. Data collected included demographics, side of hernia, incarceration, complications, duration of follow-up and need for further surgery. Comparison was made using unpaired student t test and Fishers exact test. RESULTS: Four hundred and eight patients underwent IH (365 male, 42 female, 1 complete androgen insensitivity); 197 were premature (prem), mean weight 3.81 kg (1.02-9.4); 211 were term (gestation ≥36 weeks), mean weight 5.85 kg (2.4-11.7), p = 0.0001 versus prem. Total herniotomies performed = 472 (131 Left, 213 Right, 64 bilateral); 89 hernias were incarcerated at presentation (60 prem vs. 29 term, p = 0.0001). Bowel resection was required in six patients (5 prem vs. 1 term, p = 0.1109), and 14 had simultaneous orchidopexy (12 prem vs. 2 term, p = 0.0049). Early post-operative complication rate 2.8 % (8 prem vs. 5 term; p = 0.4037). Two hundred and forty patients attended follow-up; 58.8 % (125 prem, 115 term). This group accounted for 279 IH (264 male, 15 female). Mean follow-up = 5 months (0.5-36). Complication rates: recurrence 2.7 %, metachronous hernia 7.5 %, iatrogenic cryptorchidism 3.8 % and testicular atrophy 0.7 %. CONCLUSION: No significant difference was found in complication rates between premature and term infants despite significantly more premature infants presenting with incarcerated hernias.

Knotting of a ureteric stent in a child.

Knotting of ureteric stents is an unusual complication of their use and has not previously been reported in a child. We present a case of a 4-year-old that developed symptomatic hydronephroureter following removal of a multilength stent, which had knotted at the proximal loop. The child made a full recovery but knotting must be considered if resistance is encountered during stent removal.

Sex and congenital diaphragmatic hernia.

BACKGROUND AND PURPOSE: Human studies note sex reversal syndromes and sex difference(s) in the incidence of congenital diaphragmatic hernia (CDH). Epidemiology surveys record a higher incidence of CDH in females, whilst other reports cite a higher frequency in males. Nitrofen, a teratogen, produces experimental CDH. This agent is speculated to interfere with retinoid acid-steroid signalling pathways and may also be linked with sexual differentiation. This study was designed therefore to test the hypothesis that nitrofen may influence sexual phenotype and frequency of CDH. METHODS: Time mated Sprague Dawley rats were dosed with nitrofen at day 9.5 to generate predominantly left sided CDH. Fetuses were delivered by caesarean section on days 20 or 21 of gestation (term=day 22). External genitalia were examined to define external genital phenotype. The abdominal cavity was opened and the genito-urinary system carefully examined. The internal genital organs were assigned a phenotype and findings correlated with external appearances. The diaphragm of each fetus was studied for the absence or presence of CDH and the laterality of defect recorded. Controls (non nitrofen fed) were used for all comparative analysis. RESULTS: Control (n=600) and nitrofen exposed offspring (n=504) had equal frequencies of males and females. CDH occurred with similar incidence in male and female nitrofen treated pups. In all nitrofen exposed fetuses and normal controls, internal and external genitalia concorded without evidence of significant genital tract malformations or intersex states. CONCLUSIONS: Prenatal nitrofen exposure is not associated with significant gender differences (or prenatal loss) in the risk of CDH. Genital tract malformations do not appear to accompany CDH in the nitrofen model.

Recent advances in congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) is a common birth defect which continues to challenge paediatric surgeons and intensivists. Affecting approximately 1:2500 births, a baby with CDH is born every 24-36 hours in the UK.

Bilateral ovarian autoamputation in an infant.

A case of bilateral ovarian autoamputation in an asymptomatic infant is presented. Cystic lesions were detected within the abdomen of the fetus during antenatal ultrasound scan (USS). USS performed shortly after birth showed a single lesion thought to be a duplication cyst, but at laparotomy 2 free floating cysts representing the ovaries were discovered. A review of the natural history of neonatal ovarian cysts and the management is given.