Bladder calculus formation on the tip of a migrated disused ventriculoperitoneal shunt.

Bladder stones in children are rare. They generally occur in children with one or more predisposing risk factors to stone formation. In this unique case report we discuss the formation and successful endoscopic treatment of a large stone in a neuropathic bladder on the tip of a migrated VP shunt.

Is it possible for "traditional" laparoscopic surgery to leave "invisible" scars?

BACKGROUND: Improved cosmesis is widely recognized as the main benefit of single-port laparoscopy (SPL). Recently, some centers have started to perform SPL in infants and neonates. However, in our experience, the cosmetic result following traditional laparoscopic surgery in this age range is excellent. This study assessed infants' postoperative scars following traditional laparoscopic surgery. SUBJECTS AND METHODS: Ten successive patients who previously underwent transperitoneal dismembered pyeloplasty were invited to attend for photographs of their abdominal wounds. All patients had had a 5-mm infra-umbilical port and two 3.5-mm ports (epigastrium and iliac fossa). Photographs were all taken in the hospital's medical photography studio by the same medical photographer. Life-size photographs were then shown to 10 junior doctors who were asked to identify any visible scars and rate the cosmetic result. RESULTS: Six patients with a median age at surgery of 8 months (range, 4-15 months) attended for photographs a median of 13 months postoperatively (range, 8-19 months). None of the junior doctors was able to identify all three scars on any photo. No individual scar was identifiable by all reviewers. No scars were identified in over half (31) of the total of 60 photograph reviews. Of 180 scar reviews, only 37 (21%) were identified. The umbilical scars were least noticeable (3/60), followed by iliac fossa scars (11/60) and epigastric scars (23/60). Where any scars were correctly identified, the cosmetic result was always rated good (44%) or excellent (56%). CONCLUSIONS: Traditional laparoscopic surgery in infants can have an excellent cosmetic result with "invisible" scars. The cosmetic benefit and thus the role of SPL in infants are therefore questionable.

Endoscopic nephrectomy in children: is retro the way forward?

OBJECTIVE: To determine the benefits of nephrectomy in children performed via a retroperitoneoscopic approach compared to the laparoscopic route. MATERIALS AND METHODS: We reviewed all endoscopic nephrectomies performed at our institution from August 1998 to February 2003. RESULTS: A total of 32 endoscopic nephrectomies were undertaken: 22 laparoscopic nephrectomies with 5 conversions to open surgery, and 10 retroperitoneoscopic. The main indication for surgery was poor function secondary to either reflux or obstructive nephropathy. Intraoperative heart rate changes were less marked in patients undergoing retroperitoneoscopic nephrectomy. The median operative time for retroperitoneoscopic nephrectomy was 65 minutes and 95 minutes for laparoscopy. Epidural analgesia was not required in successful endoscopic nephrectomies. The median postoperative morphine requirement in the retroperitoneoscopic group was 110mcg/kg compared to 280mcg/kg in the laparoscopic group. The majority of patients who had successful endoscopic nephrectomies were discharged to home within 2 days of surgery. CONCLUSION: Retroperitoneoscopic nephrectomy appears to be a safe technique in children, with reduced intraoperative physiological effects compared to the laparoscopic approach. Operative time was generally shorter than the laparoscopic approach and there appeared to be an additional benefit of reduced postoperative pain.