¿Sirven los hallazgos prequirúrgicos para interpretar las lesiones ováricas neoplásicas y no neoplásicas e influir en las decisiones quirúrgicas en niñas y adolescentes? / Can preoperative findings help to interpret neoplastic and non-neoplastic lesions of ovary and affect surgical decisions in children and adolescents?

Antecedentes. Las masas ováricas son frecuentes en la población pediátrica. Suele realizarse cirugía conservadora de los ovarios porque la mayoría son quistes benignos o funcionales. Objetivo. Investigar quéhallazgos prequirúrgicos sirven para diferenciar la patología de las lesiones ováricas, influir en las decisiones quirúrgicas y predecir la posibilidad de conservar los ovarios. Método. Se incluyeron pacientes operadas con diagnóstico de masa ovárica. Revisión retrospectiva de edad, síntomas, examen físico, marcadores tumorales, características radiológicas y resultados anatomopatológicos. Resultados. Durante el estudio, se operaron 98 pacientes y se incluyeron 86. Media de edad: 9,7 ± 5,62 años. Las patologías no neoplásicas representaron el 68,6 %, las neoplásicas, el 31,4 %, la tasa de malignidad, el 4,6 %. Las neoplasias incluyeron componente sólido, ausencia de torsión ovárica y diámetro >9 cm (p < 0,001;p < 0,001; p = 0,001).Se halló torsión anexial en el 34,9 %. El diámetro medio no difirió significativamente entre los grupos con o sin torsión; la incidencia de torsión fue mayor en las masas <6 cm (p = 0,019). Se realizó cirugía conservadora de los ovarios en 48 pacientes (55,8 %) y ooforectomía, en 38 (44,2 %). El tratamiento dependió de la naturaleza (p < 0,001) y del tamaño (p < 0,001) de la lesión pero no de la edad y la torsión. Conclusión. Una masa puramente quística <9 cm, con torsión y marcadores negativos indica masa no neoplásica. La presencia de un componente sólido y la ausencia de torsión están asociadas con riesgo de cáncer.

Background: Ovarian masses are common in all pediatric age groups. Ovarian-sparing surgery is favored since most cases are benign or functional cysts. Detection of a few malignant cases prevents morbidity and mortality. Objective: to investigate which of the preoperative findings can help to distinguish the pathology of the ovarian lesions, affect the surgical decision and predict the possibility of ovarian preservation. Method: Patients operated with diagnosis of ovarian mass were enrolled in the study between 2000-2015. Age, symptoms, physical examination findings, tumor markers, radiologic features, operative notes, and pathology results were reviewed retrospectively. Results: During the study period, 98 patients were operated and 86 were included. Mean age was 9.7±5.62 years. Non-neoplastic pathologies constitute 68.6 % of cases; 31.4 % was neoplastic. Malignancy rate was 4.6 %. Solid component, absence of ovarian torsion and diameter >9 cm were more commonly seen in neoplastic cases (p<0.001, p<0.001, p=0.001). Adnexal torsion was found in 30 (34.9 %) patients. Mean diameter did not differ significantly between groups with or without torsion; incidence of torsion was greater in patients with masses <6 cm (p=0.019). Ovarian-sparing surgery was performed in 48 (55.8 %) and oopherectomy in 38 (44.2 %) patients. Surgical approach was affected by nature (p<0.001) and size (p<0.001) of the lesion; it was independent of age and presence of torsion. Conclusion: A purely cystic mass <9 cm, with torsion and negative markers, orients towards a non-neoplastic mass. The presence of solid component and absence of torsion are associated with increased risk of malignancy.

Can preoperative findings help to interpret neoplastic and non-neoplastic lesions of ovary and affect surgical decisions in children and adolescents? / ¿Sirven los hallazgos prequirúrgicos para interpretar las lesiones ováricas neoplásicas y no neoplásicas e influir en las decisiones quirúrgicas en niñas y adolescentes?

BACKGROUND: Ovarian masses are common in all pediatric age groups. Ovarian-sparing surgery is favored since most cases are benign or functional cysts. Detection of a few malignant cases prevents morbidity and mortality. Objective: to investigate which of the preoperative findings can help to distinguish the pathology of the ovarian lesions, affect the surgical decision and predict the possibility of ovarian preservation. METHOD: Patients operated with diagnosis of ovarian mass were enrolled in the study between 2000-2015. Age, symptoms, physical examination findings, tumor markers, radiologic features, operative notes, and pathology results were reviewed retrospectively. RESULTS: During the study period, 98 patients were operated and 86 were included. Mean age was 9.7±5.62 years. Non-neoplastic pathologies constitute 68.6 % of cases; 31.4 % was neoplastic. Malignancy rate was 4.6 %. Solid component, absence of ovarian torsion and diameter > 9 cm were more commonly seen in neoplastic cases (p < 0.001, p < 0.001, p=0.001). Adnexal torsion was found in 30 (34.9 %) patients. Mean diameter did not differ significantly between groups with or without torsion; incidence of torsion was greater in patients with masses < 6 cm (p=0.019). Ovariansparing surgery was performed in 48 (55.8 %) and oopherectomy in 38 (44.2 %) patients. Surgical approach was affected by nature (p < 0.001) and size (p < 0.001) of the lesion; it was independent of age and presence of torsion. CONCLUSION: A purely cystic mass < 9 cm, with torsion and negative markers, orients towards a non-neoplastic mass. The presence of solid component and absence of torsion are associated with increased risk of malignancy.

Antecedentes. Las masas ováricas son frecuentes en la población pediátrica. Suele realizarse cirugía conservadora de los ovarios porque la mayoría son quistes benignos o funcionales. Objetivo. Investigar qué hallazgos prequirúrgicos sirven para diferenciar la patología de las lesiones ováricas, influir en las decisiones quirúrgicas y predecir la posibilidad de conservar los ovarios. Método. Se incluyeron pacientes operadas con diagnóstico de masa ovárica. Revisión retrospectiva de edad, síntomas, examen físico, marcadores tumorales, características radiológicas y resultados anatomopatológicos. Resultados. Durante el estudio, se operaron 98 pacientes y se incluyeron 86. Media de edad: 9,7 ± 5,62 años. Las patologías no neoplásicas representaron el 68,6 %, las neoplásicas, el 31,4 %, la tasa de malignidad, el 4,6 %. Las neoplasias incluyeron componente sólido, ausencia de torsión ovárica y diámetro > 9 cm (p< 0,001;p< 0,001; p = 0,001).Se halló torsión anexial en el 34,9 %. El diámetro medio no difirió significativamente entre los grupos con o sin torsión; la incidencia de torsión fue mayor en las masas < 6 cm (p = 0,019). Se realizó cirugía conservadora de los ovarios en 48 pacientes (55,8 %) y ooforectomía, en 38 (44,2 %). El tratamiento dependió de la naturaleza (p< 0,001) y del tamaño (p< 0,001) de la lesión pero no de la edad y la torsión. Conclusión. Una masa puramente quística < 9 cm, con torsión y marcadores negativos indica masa no neoplásica. La presencia de un componente sólido y la ausencia de torsión están asociadas con riesgo de cáncer.

Posterior sagittal anorectoplasty in vestibular fistula: with or without colostomy.

PURPOSE: The aim of this study is to compare the results and complications of one- and three-stage repairs in females with vestibular fistula (VF) and make contribution to the discussion of whether the disadvantages outweigh the protective effect of a colostomy from wound infection and wound dehiscence following posterior sagittal anorectoplasty (PSARP). METHODS: Patients with a diagnosis of VF who underwent PSARP between October 2009 and November 2015 were retrospectively reviewed. The patients were divided into two groups: Group 1-patients treated by one-stage procedure (n = 30); Group 2-patients treated by three-stage procedure (n = 16). RESULTS: There were no statistically significant differences between the groups with respect to wound infection, recurrence of fistula and rectal mucosal prolapse. Minor wound dehiscence occurred slightly more common in Group 1, even if p value is not significant. No wound dehiscence has been observed since we switched to the protocol of keeping the child nil per oral for 5 postoperative days and loperamide (0.1 mg/kg) administration for 7 postoperative days. The mean time before resuming oral intake was 2.87 ± 1.7 and 1.19 ± 0.4 days in Group 1 and Group 2, respectively (p = 0.001). None developed major wound disruption or anal stenosis in either group. There were no statistical differences between the groups in terms of voluntary bowel movements, soiling and constipation. CONCLUSIONS: PSARP performed without a protective colostomy in patients with VF has low morbidity, good continence rates and obvious advantages for both the patients and their parents.

Congenital anterior urethrocutaneous fistula: 3 new cases and review of literature.

OBJECTIVE: Congenital anterior urethrocutaneous fistula, is a rare anomaly characterised by fistulisation of penile urethra to skin and presence of a concomitant normal or hypospadiac external urethral meatus. It may be seen as an isolated anomaly or may accompany genitourinary or anorectal malformations. We aim to present 3 new cases and define the common properties of patients stated in literature. METHOD: Information of 3 patients aged 2, 3 and 6 with this diagnosis were reviewed retrospectively and features of 51 patients in 25 articles with literature search. RESULTS: From the patients we operated, 2 had midpenile and 1 had subcoronal fistula. Urethral meatus was at tip of glans in all with 1 stenotic meatus. Two-layered primary repair was performed in 3 patients and deep ventral incision on urethral plate with meatotomy were added to fistula repair in one with stenotic meatus. Fistula recurred in this patient but resolved spontaneously after dilatations. In literature, most common fistula site was subcoronal in 27 (52.9%). Hypospadias was in 11.8% and associated genitourinary anomaly was detected in 21.5% of patients. Fistula recurrence ratio was 7.8% using different surgical techniques. CONCLUSION: Congenital anterior urethrocutaneous fistula is frequently located in subcoronal level and usually a normal urethra distal to it. Physical examination is important to detect additional anomalies. Success rates are high with primary repair techniques.

The comparison of dextranomer/hyaluronic acid and polyacrylate-polyalcohol copolymers in endoscopic treatment of vesicoureteral reflux.

BACKGROUND: Dextranomer/hyaluronic acid (Dx/Ha;Dexell®) and polyacrylate-polyalcohol copolymer (PPC;Vantris®) are the popular tissue-augmenting substances using for the endoscopic injections of vesicoureteral reflux (VUR). The aim of the study is to evaluate and compare Dx/Ha and PPC in terms of effectiveness, injection techniques and complications with special emphasis on vesicoureteral junction obstruction (VUJO). METHODS: A total of 95 patients who underwent endoscopic VUR treatment between 2009 and 2015 were retrospectively reviewed. The patients were divided into two groups: group 1: Patients underwent endoscopic treatment with PPC (n=50 patients, 70 renal refluxing units) group 2: Patients underwent endoscopic treatment with Dx/Ha (n=45 patients, 74 renal refluxing units). RESULTS: The overall resolution rates based on the number of renal refluxing units studied was 88.6% and 70.3% in group 1 and group 2, respectively. Resolution rates were significantly better in group 1 compared to group 2. VUJO requiring ureteral reimplantation or stent insertion developed in 7 patients in group 1. No VUJO was observed in group 2. VUJO in group 1 was markedly higher than that in group 2. CONCLUSIONS: Endoscopic treatment of VUR with PPC promises better resolution rates but higher VUJO rates compared to Dx/Ha.

A bladder stone within a congenital paraureteral diverticulum: a case report.

Paraureteral diverticula are rare in pediatric population. We here present a bladder stone in the congenital paraureteral diverticulum presenting with vesicoureteral reflux. To the best of our knowledge, stone formation in paraureteral diverticulum has not been reported previously. A 5-year-old boy was admitted with the complaint of dysuria. Abdominal ultrasonography revealed a bladder stone in a diverticulum arising from right posterolateral wall and a small right kidney. Voiding cystourethrogram confirmed large bladder diverticulum with vesicoureteral reflux. Cystoscopy revealed a giant stone in the paraureteral diverticulum. The stone was removed with open diverticulectomy and right Cohen ureteroneocystostomy was performed.