Urothelial papilloma: a rare cause of gross haematuria in childhood.

Bladder urothelial papilloma is extremely rare in the paediatric population. It usually presents as painless gross haematuria and its diagnosis implies a high index of suspicion as other causes of haematuria predominate in this age range. We describe a 9-year-old boy with two episodes of gross haematuria occurring 1 year apart with spontaneous resolution after 2 days. Bladder ultrasound revealed an endovesical papillary lesion of 24×24 mm suggestive of bladder tumour. The diagnosis was confirmed by histopathological examination of the specimen obtained by cystoscopy with transurethral resection. After 3 years of follow-up with ultrasound and cystoscopy, there are no signs of recurrence. Due to the low prevalence of urothelial papilloma, paediatric guidelines for appropriate management and follow-up are unavailable, making this a challenging entity.

Ureteroneocystostomy after failed dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux treatment.

PURPOSE: To report our experience of open ureteroneocystostomy after failed endoscopic treatment. MATERIAL AND METHODS: Clinical charts of 787 children who entered our dextranomer/hyaluronic acid copolymer (DxHA) endoscopic injection program for vesicoureteral reflux (VUR) treatment between May 2000 and December 2009 were reviewed. Fifty-one of these patients were submitted to open ureteroneocystostomy for complete resolution of VUR. RESULTS: Twenty-eight patients (55%) were female. Median age at surgery was 65 months (range: 26-182). Median time going from first endoscopic injection until open surgery was 13 months (range 1-58). Surgical ureteral reimplantation was bilateral in 62.7% of the cases. Of a total of 83 operated ureters, nine were duplex ureters, nine were megaureters, six were ectopic, and two had periureteral diverticulum. Mean operative time was 70 min (range 45-120 min). There were no intra-operative complications. Follow-up VCUG showed complete resolution of VUR in 98% of patients. There was only one right-sided grade III VUR that persisted after bilateral reimplantation. It resolved with a single subureteral DxHA injection. CONCLUSIONS: Ureteroneocystostomy after a failed endoscopic treatment can achieve successful results in a high percentage of patients with minimal complications.

Dismembered pyeloplasty for ureteropelvic junction syndrome treatment in children.

BACKGROUND: Open dismembered pyeloplasty remains the preferred surgical technique for ureteropelvic junction syndrome (UPJS) in most paediatric urology units. The authors present their experience of 230 patients and describe their form of presentation, treatment and early and long-term results. MATERIALS AND METHODS: Retrospective analysis of clinical records of 230 patients submitted to dismembered pyeloplasty in an 8-year period, from 1999 until 2007. Pre-operative data, early and long-term complications were registered. Image studies included renopelvic ultrasonography, mercapto-acetyl triglycine (MAG3) renal scan with furosemide test and, in some cases, elimination urography and retrograde cystography. Pre-operative and post-operative results were compared. RESULTS: Median age of our patients at time of surgery was 14.9 months (range: 21 days until 16.6 years). The majority of patients were male (72%, n = 166) and 74% (n = 120) had pre-natal diagnosis. The majority of hydronephrosis were in the left side (61%, n = 141). There were only 3% of complications in early post-operative period: four had acute pyelonephritis, two had renocutaneous fistula and one died due to respiratory failure. Mean follow-up period was 5 years, ranging from 12 months to 9.7 years. There was only one case of recurrence with the need of reoperation. Comparing pre-operative and post-operative imaging results, we found that 89% had normal renal function, 7% diminished but better than before and 2% equal as before surgery. CONCLUSION: Open dismembered pyeloplasty is a safe and effective treatment in paediatric UPJS.

Varicocoelectomy in adolescents: laparoscopic versus open high ligation technique.

BACKGROUND: Treatment of varicocoele is aimed at eliminating the retrograde reflux of venous blood through the internal spermatic veins. The purpose of this investigation was to compare laparoscopic varicocoelectomy (LV) with open high ligation technique in the adolescent population. MATERIALS AND METHODS: We retrospectively evaluated 33 adolescents who underwent varicocoelectomy at our paediatric hospital, between May 2004 and September 2008. Patients were divided into two groups depending on the technique: those who had an LV and those submitted to an open varicocoelectomy (OV). We analysed side, age of surgery, follow-up period and the incidence of recurrence/persistence, hydrocoele formation and wound complication. RESULTS: There were 24 patients in the LV group and 9 in the OV group. All varicocoeles were in the left side. Mean age was 12 years in both groups. Mean follow-up time was 32 months for the LV group and 38 months for the OV group (P = 0.49). There was no significant difference in the incidence of hydrocoele in both the groups (25% versus 22%, P = 0.626). There was no recurrence/persistence on the LV group, while in the OV group there were three cases (P = 0.015). CONCLUSION: LV seems more efficient than open high ligation technique in the treatment of adolescents' varicocoeles. Larger series are necessary to draw more reliable conclusions.

[Retroperitoneal laparoscopic nephrectomy in children younger than nine years-old: state of the art]. / Nefrectomia laparoscópica retroperitoneal em crianças com idade inferior a nove anos: estado da arte.

INTRODUCTION AND AIM: In Portugal, there is very few experience in pediatric retroperitoneoscopy. The authors present the first Portuguese series of retroperitoneal laparoscopic nephrectomies (RLN) in children younger than nine years-old, as well as a literature review about the theme. MATERIAL AND METHODS: Retrospective analysis of clinical charts of all children submitted to RLN between January 2009 and December 2009 in a Pediatric Surgery Department. The literature review was made searching related articles in Medline. RESULTS: Eight RLN were preformed. The medium age of the patients was 4,5 years-old (minimum = 11 months, maximum = 8,6 years). The indications for surgery were: four multicystic kidneys, three reflux nephropathy, and one obstructive nephropathy. Four RLN were preformed on the left side. The medium operative time was 99 minutes (minimum = 50 minutes, maximum = 180 minutes). There was a shortening of operative time as the surgical team got more experienced. There were no conversions to open surgery. Medium hospital stay was 1,5 days (minimum = 1 day, maximum = 2 days). There were no intra-operative and no post-operative complications. CONCLUSIONS: RLN is feasible in children younger than nine years-old and should be considered standard treatment in pediatric population.

Upper pole nephrectomy: a simplified technique using a retroperitoneal laparoscopic approach.

Objective. To describe a simplified technique already used in our institution for several years in the open heminephrectomy for duplication anomalies, now performed through a retroperitoneal laparoscopic approach. Methods. The technique begins with upper pole parenchyma incision since the demarcation between the affected upper moiety and the healthy lower pole is easily established. The dissection proceeds until the urothelium of the collecting system is entered, which will guide further excision, minimizing damage of the surrounding structures. The vascular supply is then identified since the upper pole is attached to the remaining renal parenchyma only by these structures that can be safely divided. Dissection and division of the ectopic ureter is carried next. Results. The operative time was 188 minutes. The blood loss was not significant, and there were no other complications during the procedure. The patient was discharged home 48 hours after the procedure, without any early or late postoperative complications. Conclusion. We believe this simplified technique allows a safer excision of nonfunctioning upper pole renal tissue by avoiding the initial dissection of the renal hilum, which associated with the known advantages of a laparoscopic approach makes us consider it the procedure of choice for upper pole nephrectomy in children.

[The treatment of vesicoureteral reflux]. / Tratamiento de reflujo vesicoureteral.

OBJECTIVES: Vesicoureteral reflux (VUR) is a frequent pathology, with an incidence of 29/50% in children studied for urinary tract infection (UTI) and 20% of newborns with the diagnosis of prenatal hydronephrosis. Over the years, the treatment has been the subject of many meetings, many research studies, and continues being a topic under discussion. The number of candidates for surgical treatment increased with the development of minimally invasive endoscopic techniques by subureteral injection of bulking agents. We present the results of the surgical treatment of VUR between 2001 and 2006. METHODS: We performed a retrospective study of the endoscopic treatment of VUR by subureteral injection of Dextranomer and hyaluronic acid copolymer (Copol-Dx/AH). All children undergoing treatment between July 1st 2001 and December 30th 2006 were included in this study. Treatment was performed in children with VUR grade II or greater. All patients presenting no reflux or grade I VUR on control VCUG were considered cured; stopping antibiotic prophylaxis was proposed in these cases. RESULTS: 661 children underwent treatment, 607 endoscopic and 54 with the Cohen technique. Among children treated endoscopically, 437 where females and 170 males. VUR was bilateral in 37.7% of the cases, with grade II being the most frequent (40% in males and 57% in females). Overall success rate was 70% after first treatment, 75% after second treatment and increased to 78% after the third. CONCLUSIONS: Subureteral injection of dextranomer and hyaluronic acid copolymer is on effective treatment in children with VUR, independently of the grade. It is a simple, safe, well tolerated procedure with low associated morbidity. Currently, it is the surgical treatment of choice in most patients with VUR.

Tratamiento de reflujo vesicoureteral / The treatment of vesicoureteral reflux

Objetivo: El reflujo vesicoureteral (RVU) es una patología frecuente, con una incidencia de 29/50% en niños estudiados por infección del tracto urinario (ITU) y de 20% en recién nacidos con diagnóstico pre-natal de hidronefrosis. A lo largo de los años, la terapéutica ha sido motivo de muchas reuniones, de muchos trabajos de investigación y continúa siendo un tema discutido. Con el desarrollo de técnicas endoscópicas de mínima invasión, por inyección sub-ureteral de “bulking agents”, el grupo de candidatos a tratamiento quirúrgico aumentó. Presentamos los resultados del tratamiento quirúrgico de RVU de 2001 a 2006. Métodos: Se realizó un estudio retrospectivo de tratamiento endoscópico de RVU con inyección sub-ureteral de copolimero de dextranomero ácido hialurónico (Copol-Dx/AH). Se incluyeron todos los niños tratadas en el periodo comprendido entre 1/ Julio/ 2001 a 30/ Diciembre/ 2006. El tratamiento se realizó en niños con un reflujo mínimo de grado II o superior. Se consideró tratados a los pacientes que presentaban una CUMS de control sin reflujo o con reflujo vesico ureteral grado I, proponiéndose en estos casos la suspensión de la profilaxis antibiótica de ITU. Resultados: Se trataron 661 niños, 607 por vía endoscopia y 54 por técnica de Cohen. De los niños tratados endoscopicamente, 437 eran de sexo femenino y 170 de sexo masculino. El RVU era bilateral en 37,7% de los casos, siendo el grado II el más frecuente (40% en el sexo masculino y 57% en el femenino). La tasa global de éxito fue de 70% después del primer tratamiento, de 75% después del segundo tratamiento y subió para 78% después del tercero. Conclusiones: La inyección sub-ureteral de copolímero de dextranomero ácido hialurónico es un tratamiento eficaz en niños con RVU, con indiferencia del grado de reflujo. Es un procedimiento sencillo, seguro, bien tolerado y con baja morbilidad. Es, en este momento, el tratamiento quirúrgico de elección en la mayor parte de los pacientes con RVU (AU)

Objectives: Vesicoureteral reflux (VUR) is a frequent pathology, with an incidence of 29/50% in children studied for urinary tract infection (UTI) and 20% of newborns with the diagnosis of prenatal hydronephrosis. Over the years, the treatment has been the subject of many meetings, many research studies, and continues being a topic under discussion. The number of candidates for surgical treatment increased with the development of minimally invasive endoscopic techniques by subureteral injection of bulking agents. We present the results of the surgical treatment of VUR between 2001 and 2006. Methods: We performed a retrospective study of the endoscopic treatment of VUR by subureteral injection of Dextranomer and hyaluronic acid copolymer (Copol-Dx/AH). All children undergoing treatment between July 1st 2001 and December 30th 2006 were included in this study. Treatment was performed in children with VUR grade II or greater. All patients presenting no reflux or grade I VUR on control VCUG were considered cured; stopping antibiotic prophylaxis was proposed in these cases. Results: 661 children underwent treatment, 607 endoscopic and 54 with the Cohen technique. Among children treated endoscopically, 437 where females and 170 males. VUR was bilateral in 37.7% of the cases, with grade II being the most frequent (40% in males and 57% in females). Overall success rate was 70% after first treatment, 75% after second treatment and increased to 78% after the third. Conclusions: Subureteral injection of dextranomer and hyaluronic acid copolymer is an effective treatment in children with VUR, independently of the grade. It is a simple, safe, well tolerated procedure with low associated morbidity. Currently, it is the surgical treatment of choice in most patients with VUR (AU)

[Goldenhar syndrome associated to posterior urethral valves]. / Síndrome de goldenhar asociado a válvulas de la uretra posterior.

OBJECTIVE: To report a case with Goldenhar syndrome with posterior urethral valves. METHODS: Goldenhar syndrome (oculoauriculovertebral dysplasia) is a condition featuring the following triad of anomalies: ocular abnormalities (epibulbar dermoids, coloboma), otic anomalies (low set ears, auricular appendage) and/or vertebral anomalies. Multiple malformations, including congenital heart, brain and renal disease. RESULTS: Posterior urethral valves should be treated with primary valve ablation. CONCLUSIONS: It is necessary to perform a careful evaluations of general malformations, especially renal malformations.

Síndrome de Goldenhar asociado a válvulas de la uretra posterior / Goldenhar syndrome associated to posterior urethral valves

OBJETIVOS: Presentamos un caso con síndrome de Goldenhar con válvulas de la uretra posterior. METODOS: El Síndrome de Goldenhar (displasia oculoaurículovertebral) es una entidad infrecuente que se caracteriza por anomalías: oculares (dermoides epibulbares, colobomas), auriculares (baja implantación auricular, apéndices preauriculares) y/o anomalías vertebrales, asociado a múltiples malformaciones cardíacas, cerebrales y renales. RESULTADOS: Realizamos electrofulguración de las válvulas de la uretra posterior, teniendo buena evolución. CONCLUSIONES: Los niños nacidos con Síndrome de Goldenhar deberían someterse a pruebas de imagen para detectar anormalidades del aparato urinario superior e inferior (AU)

OBJECTIVE: To report a case with Goldenhar syndrome with posterior urethral valves. METHODS: Goldenhar syndrome (oculoauriculovertebral dysplasia) is a condition featuring the following triad of anomalies: ocular abnormalities (epibulbar dermoids, coloboma), otic anomalies (low set ears, auricular appendage) and/or vertebral anomalies. Multiple malformations, including congenital heart, brain and renal disease. RESULTS: Posterior urethral valves should be treated with primary valve ablation. CONCLUSIONS: It is necessary to perform a careful evaluations of general malformations, especially renal malformations