Anterior urethral valves: a rate cause of urethral obstruction in children

Anterior urethral valves are uncommon cause of urethral obstruction in children and diagnosis may be delayed due to rarity of condition. The symptoms mimic those of posterior urethral valves. We are reporting a four years old boy who presented with recurrent urinary tract infections, difficulty in micturition and dribbling of urine. Ultrasound showed bilateral hydronephrosis, hydrouerter and a large bladder with 100 ml of post voiding residual urine. Micturating cystourethrogram showed trabeculated bladder with dilated urethra to the navicular fossa. Cystoscopy revealed fibrous valves just proximal to the navicular fossa. Ablation of valves caused immediate relief of symptoms. Child remained symptoms free at six months follow-up

Intralesional bleomycin injection- A primary therapy for peripheral lymphangiomas

To evaluate the efficacy of intralesional Bleomycin Injection [IBI] as a primary therapy for peripheral lymphangiomas in children. A prospective study was conducted at NICH Karachi from January 2003 to December 2005. Patients with peripheral lymphangiomas were included in the study. Exclusion criteria included previously treated lymphangiomas, infected lesions, intra-thoracic and intra-abdominal lesions. Thirty three patients were included in the study. All were treated with Intralesional Bleomycin Injection [IBI]. After aspiration of fluid from the lesion, 0.5 mg/kg of Bleomycin diluted in saline was administered at different sites into the lesion. Depending upon the size of lesion and age of patient, procedure was performed in operating theatre under local or general anesthesia. Reduction in size was seen in 90% cases [n=29], out of them 30% [n=10] showed near complete disappearance and 63% [n=21] showed good response. Two patients [6%] showed poor response and they underwent surgery. Few patients had minor complications like fever, pain, redness and increase in the size after injection. All these complications were managed conservatively with symptomatic treatment and no patient required hospitalization. IBI is an effective therapy for lymphangiomas, with results comparable to surgical excision. It has the added advantage of avoiding inadvertent injury to vital structures, scarring and other complications of surgery. We recommend it as a primary therapy for all peripheral lymphangiomas