Kim A.R. Hutton

PERCUTANEOUS RETRIEVAL OF AN INTRAVESICAL FOREIGN BODY USING DIRECT TRANSURETHRAL VISUALIZATION: A TECHNIQUE APPLICABLE TO SMALL CHILDREN

(Fig. 1). The retained catheter length was then visualized, Indications manipulated and secured with laparoscopic grasping forceps (Richard Wolf Cat. no. 8393.241) and withdrawn Intravesical foreign bodies in both adults and children are rare; several have occurred after self-insertion or via the 5-mm port whilst maintaining transurethral endoscopic vision (Fig. 2). A new suprapubic catheter, migration from adjacent organs [1]. Iatrogenically introduced foreign bodies have been reported and may result required for acute bladder emptying problems after posterior sagittal anorectoplasty, was inserted successfully from severed or retained catheter tips [1,2], the migration of urethral stents used in reconstructive urological proand the patient made an uneventful recovery. On followup, bladder function returned to normal within a few cedures (e.g. hypospadias repair) [3] or present as bladder calculi subsequent to retained suture material or staples weeks and the suprapubic catheter was therefore removed. from previous surgery [4]. In contrast to bladder foreign bodies in adults, which can usually be retrieved endoscopically with or without urethral dilatation [1], the size Comparison with other methods of the paediatric urethra may prevent successful transurethral removal. We describe a percutaneous technique The extraction of intravesical foreign bodies should be complete, using a technique that is simple and minimizes for the removal of intravesical foreign bodies in children that avoids both undue urethral trauma and open bladder and urethral trauma. Safe transurethral removal in children may not be possible because of the small surgery. The technique incorporates the same basic principles applied by Badlani et al. [5] but uses more calibre, delicate nature or previous surgical reconstruction of the urethra. Although a recent report described recent commercially available equipment designed for laparoscopic use. laparoscopic removal of an intravesical foreign body in an adult, the technique used multiple suprapubic trocar punctures for both instrument and optical access [6]. Method The present technique of direct transurethral visualization simplifies the procedure, minimizes the need for A retained Silastic suprapubic catheter length, severed after percutaneous ‘peel-away’ metal trocar insertion, repeated percutaneous bladder puncture and thereby reduces the likelihood of postoperative urinary extravawas retrieved percutaneously from the bladder of a 4-month-old infant. The procedure was performed under sation. Open cystotomy is more invasive than percutaneous retrieval and likely to be associated with general endotracheal anaesthesia with the patient in the lithotomy position. A suitably sized cysto-urethroscope increased operative time and longer convalescence. was passed per urethra to visualize the foreign body and fill the bladder with irrigating fluid. The bladder was Advantages and disadvantages then palpated and subsequently tapped with a 21 G needle in a position deemed suitable for percutaneous The percutaneous endoscopic approach provides a minimally invasive means of retrieving intravesical foreign retrieval, while observing the process through the cystourethroscope. Through the same suprapubic approach a bodies. It is simple and direct vision provides safe access to the bladder interior. Percutaneous removal avoids 5-mm disposable laparoscopy port (SurgiportA Cat. no. 171031, Autosuture, UK) was inserted percutaneously damaging the ‘delicate’ paediatric urethra or neourethra. The technique has the potential for inadvertent injury into the bladder under direct vision thereby avoiding injury to the posterior bladder wall or bladder neck area to other organs and may be contraindicated in patients

Pilomatricomas in Turner syndrome.

Abstract:  Pilomatricomas are benign, cutaneous tumors of the hair matrix cells, which present predominantly in childhood. Although usually an isolated finding, they have been described in association with several inherited conditions. We report a 10‐year‐old girl with Turner syndrome who has two pilomatricomas, including one giant tumor. In combination with a previous report of pilomatricoma in two patients with Turner syndrome, our observation indicates that it is likely a real, although uncommon, association of pilomatricomas with Turner syndrome exists.. This apparent predisposition may be etiologically related to the abnormalities of hair‐bearing skin observed in Turner syndrome. Doctors involved in the diagnosis and management of cutaneous masses in children should be aware of this association.

Ballooning of the foreskin and physiological phimosis: is there any objective evidence of obstructed voiding?

To determine whether physiological phimosis with or without ballooning of the prepuce is associated with noninvasive urodynamic or radiological evidence of bladder outlet obstruction.

Normal anatomy of the external urethral meatus in boys: implications for hypospadias repair

Both papers in this section relate to the always difficult subject of hypospadias repair. One of them describes the anatomy of the external urethral meatus, and the other a technique for repairing coronal or subcoronal hypospadias.

Abdominal Cystic Lymphangioma Mimicking Appendicitis

A cystic lymphangioma arising within the abdomen is a rare entity in children. It may present with an abdominal mass and symptoms of abdominal pain, vomiting, and anorexia. These nonspecific clinical symptoms are often attributed to more common acute pediatric conditions. In this report, we describe two pediatric cases of intra-abdominal cystic lymphangioma that were initially diagnosed and treated as appendicitis. True diagnosis was only achieved on surgical excision and pathological investigation of cystic material.

A new operative technique – Extra renal ureterocalycostomy for correction of PUJ obstruction in a horseshoe kidney

The authors describe a novel operative technique in a child with PUJ obstruction in a horseshoe kidney, where a pyeloplasty was clinically indicated but unsafe because of insufficient length of ureter and predicted technical difficulty in transposing large renal vessels coursing to the renal hilum. During the operation, there was a favourably positioned extra renal lower pole calyceal infundibulum identified, of similar dimensions to the spatulated ureter and this was chosen for an end to side tension free anastomosis. As far as the authors are aware this technique of extra renal ureterocalycostomy has not been described before.

Vesicolithiasis associated with posterior urethral valves

A 2-year-old boy was admitted as an emergency with severe screaming episodes related to extreme dysuria and urinary retention; he had a 4-month history of intermittent dysuria, recurrent UTI and balanitis. Abdominal ultrasonography showed a large vesical calculus (2.5 cm diameter) at the bladder neck (Fig. 1) and a distended bladder; the upper tracts were normal. Before open stone removal cysto-urethroscopy was undertaken, which surprisingly showed obstructive type I PUV; these were resected (Fig. 2). He is now asymptomatic 1 year after surgery, with no further UTI, no stone recurrence and no residual PUV or postvoid residual volume on imaging.

Cystoscopic removal of a JJ stent using a suture ‘lasso’

Concerning the management of the nine patients reported by Pepper et al. , the diagnostic and therapeutic criteria for managing suspected lymphoceles were neither defined nor standardised. Some patients were actively treated, others not, but the criteria on which these decision were based are unclear. Thus an evaluation of the chosen strategies is impossible. Also, the case number of nine lymphoceles, apart from representing a gross underestimation of the true incidence of lymphoceles, would be rather small for determining ‘the best method of diagnosis and treatment’.