Sujata Jali

Staged buccal mucosa urethroplasty in reoperative hypospadias

Introduction: Repeated attempts at surgical repair of serious complications involving either the partial or complete breakdown of the hypospadias repair are less likely to succeed because the penis is densely scarred, or significantly shortened, and the skin over the penis is immobile and hypovascular. Buccal mucosa (BM) has become the preferred material for reconstruction, whenever a child with skin-deficient hypospadias needs reoperation. We report the results of our surgical experience with staged reoperation using BM, in the repair of hypospadias in children with complications after multiple failed repairs. Materials and Methods: Children needing reoperation for hypospadias underwent a staged repair using buccal mucosa. The complications were noted. Results: Twenty-one children aged 3 – 16 years underwent this staged repair during the period May 2000 – April 2010. Two of these 21 children had a failed first stage. One child developed a urethro-cutaneous fistula following the second stage, which was corrected in an additional stage. Conclusions: The use of the buccal mucosa graft for urethral reconstruction in a child with hypospadias, needing a reoperation, is a successful method, with a low incidence of complications.

Laparoscopic mitrofanoff appendicovesicostomy: Our experience in children

Introduction: The Mitrofanoff principle was originally described as a method to provide an alternative means to access the bladder. It creates a conduit to the bladder through which patients with a sensitive, absent, or traumatized urethra can perform clean intermittent catheterization (CIC) easily. We report our experience with complete laparoscopic Mitrofanoff appendicovesicostomy to promote a catheterizable abdominal stoma. Materials and Methods: A 4-port transperitoneal approach was used to create a complete laparoscopic Mitrofanoff appendicovesicostomy. Results: Six children with a mean age of 12.8 years (range 9-16 years) underwent laparoscopic Mitrofanoff appendicovesicostomy. Mean operative time was 139.6 min and Mean estimated blood loss was 46 cc. No cases of urinary leaks were noted. There have been no cases of either stomal stenosis or appendicovesical stenosis noted. Conclusions: Pure laparoscopic Mitrofanoff appendicovesicostomy is feasible and is associated with reasonable outcome with early recovery, resumption of normal activities and excellent cosmesis.

Preliminary experience with laparoscopic Foley's YV plasty for ureteropelvic junction obstruction in children

INTRODUCTION: Laparoscopic dismembered pyeloplasty is an acceptable option for ureteropelvic junction (UPJ) obstruction in the paediatric population. We compared our results of laparoscopic dismembered and non-dismembered Foleys YV pyeloplasty. MATERIALS AND METHODS: Children presenting with hydronephrosis secondary to UPJ obstruction formed the study group. Foleys YV plasty was planned whenever it was observed that a tension free dismembered pyeloplasty was not possible in spite of all possible manoeuvres. Children were followed up for urinary infection, and renogram was repeated after 3 months. RESULTS: During the study period, 108 children (63 male and 45 female) with a mean age of 4.94 ± 2.78 years underwent laparoscopic dismembered pyeloplasty and the remaining 11 children (5 male and 6 female) with a mean age of 4.00 ± 1.776 years underwent laparoscopic Foleys YV plasty. There were no major peri-operative complications noted and conversion to open was not necessary in any child. Renogram done at 3 months post-operatively showed good drainage and improvement of renal function. CONCLUSIONS: Laparoscopic Foleys YV pyeloplasty is a safe and effective technique in appropriately selected cases of primary UPJ obstruction in children.

Contribution of SWEET to improve paediatric diabetes care in developing countries.

Diabetes affects many children living in developing countries. Through an informal survey, five SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) centers from developing countries (Mali, Costa Rica, Argentina and two from India) share their perspective on caring for children with diabetes. Each center provides a description of the population of children with diabetes they serve, the organization of care, and the challenges encountered on a daily basis in the provision of this care. In the second part, we summarize the anticipated benefits and challenges associated with participation in SWEET. This resulting article is a testimony of the reality of managing diabetes by dynamic teams striving to achieve recommended standards of care for pediatric diabetes in an environment with limited resources.

Laparoscopic Mitrofanoff continent catheterisable stoma in children with spina bifida.

Background: In 1980, Mitrofanoff described the creation of an appendicovesicostomy for continent urinary diversion. This procedure greatly facilitates clean intermittent catheterisation in patients with neurogenic bladder. The purpose of our study was to determine the clinical efficacy of the laparoscopic Mitrofanoff catheterisable stoma for children and adolescents with spina bifida. Materials and Methods: Review of hospital records revealed that 11 children with spina bifida underwent a laparoscopic Mitrofanoff procedure with at least 1-year of follow-up. A four-port transperitoneal laparoscopic approach was used to create a Mitrofanoff appendicovesicostomy. The child was followed-up in the urology clinic at 6 weeks, 3 months, 6 months, 1-year, and then semiannually after that. Questionnaires were administered to determine, from the children′s perspective, the level of satisfaction with catheterisation and the psychosocial implications of catheterisation before and after the creation of the Mitrofanoff continent catheterisable stoma. Results: Of the 11 children, six were female, and five were male. The mean age at presentation to Paediatric urological services was 11 × 3.22 years. Overall the mean operative time was 144.09 × 17.00 min. Mean estimated blood loss was 37.36 × 11.44 cc. None of the cases needed conversion to open. Patient satisfaction with their catheterisation was measured at 2.18 × 0.98 preoperatively, Post-operatively, this improved to 4.27 × 0.46. Statistical analysis using paired t-test showed significance with P < 001. Conclusions: Laparoscopic Mitrofanoff catheterisable stoma is feasible in children with spina bifida and is associated with reasonable outcome with early recovery, resumption of normal activities and excellent cosmesis.

Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: Data from the international SWEET registry

To assess the prevalence of underweight (UW), overweight (OW), and obesity in children and adolescents with type 1 diabetes (T1D).

Information Technology-Assisted Treatment Planning and Performance Assessment For Severe Thalassemia Care in a resource-limited setting (Preprint)

Background Successful models of information and communication technology (ICT) applied to cost-effective delivery of quality care in low- and middle-income countries (LMIC) are an increasing necessity. Severe thalassemia is one of the most common life-threatening noncommunicable diseases of children globally. Objective The aim was to study the impact of ICT on quality of care for severe thalassemia patients in LMIC. Methods A total of 1110 patients with severe thalassemia from five centers in India were followed over a 1-year period. The impact of consistent use of a Web-based platform designed to assist comprehensive management of severe thalassemia (ThalCare) on key indicators of quality of care such as minimum (pretransfusion) hemoglobin, serum ferritin, liver size, and spleen size were assessed. Results Overall improvements in initial hemoglobin, ferritin, and liver and spleen size were significant (P<.001 for each). For four centers, the improvement in mean pretransfusion hemoglobin level was statistically significant (P<.001). Four of five centers achieved reduction in mean ferritin levels, with two displaying a significant drop in ferritin (P=.004 and P<.001). One of the five centers did not record liver and spleen size on palpation, but of the remaining four centers, two witnessed a large drop in liver and spleen size (P<.01), one witnessed moderate drop (P=.05 for liver; P=.03 for spleen size), while the fourth witnessed a moderate increase in liver size (P=.08) and insignificant change in spleen size (P=.12). Conclusions Implementation of computer-assisted treatment planning and performance assessment consistently and positively impacted indexes reflecting effective delivery of care to patients suffering from severe thalassemia in LMIC.

Modified Cantwell-Ransley epispadias repair in children our experience

Introduction: We retrospectively evaluated our experience with modified Cantwell-Ransley epispadias repair at our center to determine the complications and long-term results. Materials and Methods: We retrospectively reviewed the case records of 43 male children with a mean age of 9.13 ± 1.94 years who underwent primary epispadias repair at our center. The results of epispadias repair were assessed by both physical and endoscopic examination. All children who were old enough to opine as well as all parents/guardians were interviewed during the follow-up visits. Results: Urethrocutaneous fistulae occurred in 17.85% (5/28) children of the classic bladder exstrophy group and in 13.33% (2/15) children with penopubic epispadias. Postoperative cystoscopy done 12 weeks after repair revealed a smooth urethral tube in 81.39% (35/43) of children. With the patient in a standing position, the penis was dangling downward or in a horizontal position in 88.37% (38) of children, 85% of the patients ≥18 years of age were satisfied with both the functional and cosmetic outcome, as assessed by short form 36 and 93.02% (40/43) of the patients were continent during the daytime with voided volumes of more than 200 ml. Conclusion: In our experience, Cantwell-Ransley repair creates a functionally and cosmetically acceptable penis and produces a reliably tubularized neourethra with acceptable complication rates.

Inflammatory pseudotumor of the bladder in a child

Inflammatory pseudotumors of the bladder are rare in children. We report here the case of an 11-year-old child who presented with lower urinary tract symptoms. Ultrasonography and computed tomography imaging of abdomen showed an intravesical mass/thickening arising from the right lateral wall. Biopsy of the lesion revealed a lesion that showed uniform elongated spindle cells within a background of myxoid stroma. The cells were loosely packed from a smooth muscle lesion, which had a densely packed cellular stroma. The child improved with a course of antibiotics and a repeat imaging showed disappearance of the lesion.

Migratory polyarthritis in aleukemic lymphoblastic leukemia: An undesignated paraneoplastic syndrome

Arthritic presentation of childhood acute leukemias is well known. A subset of these children may have peripheral blast cells undetectable (aleukemic leukemia). We report classical asymmetric, fleeting type of polyarthritis involving the large weight-bearing joints along with remittent fever and normal leukocyte counts as a presenting feature of acute lymphoblastic aleukemic leukemia, deliberated as a ′paraneoplastic syndrome′ of childhood.