Himanshu Acharya

Urethral duplication in children: Our experience of eight cases

OBJECTIVE Duplication of urethra has varied presentations and multiple techniques have been described for its correction. We present our experience in the management of this anomaly. MATERIAL AND METHOD We retrospectively reviewed the records of eight patients treated for urethral duplication in 1998-2008. We managed four cases of Y-duplication, three of whom underwent buccal mucosal tube urethroplasty and one urethrourethrostomy. Two patients presented with double stream (type II A2); in one urethrourethrostomy was done and the other child underwent vesicostomy as initial treatment. Two cases were of type II B duplication (two urethra opening as single meatus); one required only dilatation of urethra and the other excision of accessory tract. RESULT Mean age at presentation was 56.9 months. Associated anomaly was present in only two patients. Single-stage procedure was done in four patients and multi-staged procedure in three patients. Overall mean number of procedures required was 2.8; more were required in the case of Y-duplication compared to the other types. On follow-up all patients were passing urine in single stream. CONCLUSION Thorough work up to detect any associated anomaly and type of duplication is required for the management of urethral duplication. Single-stage repair with buccal mucosa as tube urethroplasty in cases of Y-duplication is feasible with good outcome.

Our Experience of Ureteral Substitution in Pediatric Age Group

OBJECTIVES To find appropriate ureteric substitute in the pediatric age group. METHODS Retrospective analysis was done from 2003 to 2008 of all patients operated in our hospital who had undergone ureteric replacement. All cases were followed up to find conduit patency, renal function, and any related complication. RESULTS Ureteric replacement was performed in 5 cases. Age of the patients ranged from 6 months to 9 years. Three cases were of obstructive megaureter; 1 of redo-pyeloplasty and 1 of iatrogenic injury of the ureter. Three patients underwent partial ureteric substitution of the right ureter, and complete replacement of the left ureter with appendix was performed in 1 patient. In 1 case small bowel was used as Monti tube to substitute the ureter. At median follow-up of 23 months (14-66 months) all patients were well except 1 whose kidney function had deteriorated. CONCLUSIONS We believe that our small series supports that either appendix or small bowel should be considered as Montis tube for ureteric replacement when confronting with short ureter in pediatric age group.

Single-stage feminizing genitoplasty in aphallia through an anterior saggital approach

PURPOSE An ideal feminizing genitoplasty in aphallia should achieve good cosmesis and capacious vagina in a single-stage repair. Most of the techniques described in the literature are variations of the posterior sagittal approach with staged repair. We describe a single-stage anterior sagittal approach for feminizing genitoplasty in cases of aphallia. MATERIALS AND METHODS A case of aphallia was operated through an anterior sagittal approach, and a spiral Monti tube of sigmoid colon was used to create a neovagina. Preservation of the skin tag around the urethra and its placement in the perineum gives it the appearance of the clitoris. RESULT The patient has been observed for 7 months. She is continent and has a satisfactory cosmetic appearance and capacious vagina. CONCLUSION A single-stage operation through an anterior sagittal approach is a good alternative technique for genital reconstruction in the case of aphallia.

Posterior urethral valves with vesical calculus: A rare association

Posterior urethral valve and vesical calculus are individually among the most common causes of obstructive lower urinary complaints in children. There are very few reports of association between posterior urethral valves and bladder calculus. We report three such cases. This association of the vesical calculi with posterior urethral valves may lead to a delay in the diagnosis of the posterior urethral valves. The diagnosis of posterior urethral valves should be suspected in all children with vesical or urethral calculi who have persistence of symptoms even after removal of the calculi.

Mesentric Cyst- An Unusual Presentation as Inguinal Hernia

Mesenteric cyst is one of the uncommon childhood tumors. Mostly they are asymptomatic. Some of them present with non specific abdominal symptom like chronic abdominal pain very rarely they present as acute abdomen like torsion or intestinal obstruction. We are reporting a very rare presentation of Mesenteric cyst as an irreducible inguinal hernia.

Biliary atresia associated with choledochal cyst

Choledochal cyst and biliary atresia are rare but important causes of neonatal jaundice. Both present with jaundice and acholic stool in neonatal period. Treatment and prognosis of both entities are very different. We are presenting a case in which choledochal cyst co-existed with biliary atresia; the antenatal diagnosis was that of choledochal cyst. Patient had cyst excision with hepatojejnostomy, but ultimately required portoenterostomy because of associated biliary atresia. We conclude that choledochal cyst and biliary atresia are two entities with similar antenatal and postnatal presentation; they should be differentiated as management and prognosis are different.

Bilateral empyema thoracis treated simultaneously with video-assisted thoracic surgery and open decortication: a case report and review of the literature

Empyema thoracis is a complication and a late sequel of untreated pneumonia in children. The reviews published on bilateral empyema are very few. We present a case that was managed bilaterally simultaneously with good results, and we also present a review of the current trend of management of this entity.

Rectal diaphragm in a patient with imperforate anus and rectoprostatic fistula.

The association of rectal diaphragm in an imperforate anus has not been reported until now. A 1-year-old male presented with right transverse colostomy for high anorectal malformation. The patient had imperforate anus and a recto-prostatic fistula with rectal diaphragm. We managed the case by an ano-rectal pull through with excision of the diaphragm.

Use of the processus vaginalis: A new technique for reinforcing the neourethra in hypospadias associated with undescended testis

Incidence of the undescended testis (UDT) along with hypospadias varies from 6 to 31%. The repair of UDT and hypospadias is rarely done simultaneously. Here we present a novel technique that uses processus vaginalis as vascular cover for neourethra in hyposapdias patients with UDT. We have done urethroplasty and orchiopexy simultaneously. This is the first report of processus vaginalis being used to reinforce the urethra.