Acute Epididymitis in Children: the Role of the Urine Test

PURPOSE: Acute epididymitis is considered to have an important role in children with scrotal pain. Recent reports have shown that urinalysis is not helpful for the diagnosis and treatment of acute epididymitis owing to negative microbiological findings. Therefore, we analyzed clinical and laboratory characteristics to examine the diagnostic yield of urinalysis in children. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 139 patients who were diagnosed with acute epididymitis from 2005 to 2011. Diagnosis was based on symptoms, physical findings, and color Doppler ultrasonography (DUS). To investigate the characteristics of epididymitis in children, the patients were divided into 3 groups: group A (aged less than 18 years, 76 patients), group B (18 to 35 years old, 19 patients), and group C (older than 35 years, 44 patients). RESULTS: There were statistically significant differences in age, symptom duration, hospital stays, and lesion location in each group. White blood cell count and serum C-reactive protein levels, pyuria, and positive urine culture results were statistically higher in the older age group. The most common cause of acute epididymitis in children was idiopathic (96.1%). CONCLUSIONS: In our group of children with epididymitis, 73 cases out of 76 (96.1%) resulted in negative pyuria in urinalysis. In addition, the most common cause of epididymitis was idiopathic. Because most urinalyses do not show pyuria, we believe that routine antibiotics may be not required in pediatric patients with epididymitis. If urinalysis shows pyuria with or without positive urine culture, antibiotics should be considered.

Penile Epidermal Cyst in a Patient With Augmentation Penoplasty

A 44-year-old male patient who had undergone augmentation penoplasty 20 years previously presented with a slowly growing penoscrotal mass. The penile mass was excised totally and the pathologic diagnosis was an epidermal cyst. Epidermal cysts are benign disorders that can occur in any part of the body. However, an epidermal cyst as a late complication of augmentation penoplasty is extremely rare. We report this case of a penile epidermal cyst that developed after augmentation penoplasty.

Prognostic Influence of Coagulative Tumor Necrosis and the Tumor Location for T1a Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: The presence of histologic coagulative necrosis in the primary tumors of patients with renal cell carcinoma has been suggested to be an important predictor of survival. This study aimed to evaluate the relationship of tumor necrosis and tumor location as compared to the other clinical features. MATERIALS AND METHODS: From June 1995 to April 2004 we retrospectively reviewed the records of 204 patients who underwent unilateral radical nephrectomy for stage T1a renal cell carcinoma. The presence of histologic coagulative necrosis in the primary tumors was recorded and the location of tumor was classified based on the computed tomography (CT) scan. Overall survival was estimated using the Kaplan-Meier method and the log-rank test, and the prognostic factors that influenced on survival were estimated using the Cox proportional hazard regression model. RESULTS: In this study, radical nephrectomy was performed in 148 men and 56 women with a mean age of 54.9 years (age range: 23 to 77). The mean follow-up was 31.3 months (range: 6 to 106 months). The average size of the renal cell carcinoma was 3.0cm (range: 1 to 4). The tumor locations were categorized into 2 types according to the centrality and verticality. The incidence of necrosis in T1a renal cell carcinoma was 8.7% (n=18). On the analysis of the overall survival using the log rank test, tumor necrosis (p=0.01) was a statistically significant factor. CONCLUSIONS: For the patients with T1a renal cell carcinoma (2002 TNM stage), the presence of tumor necrosis was significantly associated with overall survival.

Transperitoneal Laparoscopic Removal of Adrenal Ganglioneuroma / 대한비뇨기과학회지

Ganglioneuroma is generally considered to be a benign tumor arising from neural crest tissue. An adrenal ganglioneuroma is located within the substance of the adrenal medulla or along the sympathetic chain, thus may secrete catecholamines, and present with endocrine symptoms. However, nonfunctional growths remain silent until they reach a large size, and are usually discovered incidentally. Complete surgical excision of adrenal ganglioneuroma is the treatment of choice, and especially a laparoscopic adrenalectomy can be performed safely, and is an ideal substitute to an open procedure, with the added benefits associated with minimally invasive surgery. Herein, we report a case of an incidentally discovered adrenal ganglioneuroma.

The Natural Course in Children with Unilateral Multicystic Dysplastic Kidney / 대한비뇨기과학회지

PURPOSE: Advances in modern ultrasonography combined with a dimercaptosuccinic acid (DMSA) renal scan have permitted the diagnosis of a multicystic dysplastic kidney (MCDK) with a high degree of certainty. Most multicystic dysplastic kidneys undergo spontaneous involution during follow-up, as demonstrated by serial ultrasonography. The purpose of this study was to contribute to a better understanding of the natural history of a MCDK, and suggest guidelines for follow-up of a MCDK. MATERIALS AND METHODS: Between November 1988 and May 2004, 142 children with a MCDK were diagnosed at our institute. A retrospective data analysis was carried out on 38 patients who were conservatively managed and followed for more than 6 months. Follow up ultrasonography examinations were performed every 6 months until patients were 5 years old, and annually thereafter. Patients were divided into simple and complex MCDK based on postnatal physical examination and renal ultrasonography. A simple MCDK was defined as unilateral renal dysplasia without genitourinary abnormalities. Complex MCDK included patients with unilateral renal dysplasia, but with other genitourinary abnormalities. RESULTS: The follow-up periods ranged from 6 to 76 months, with a median of 21.5 months. Partial and complete involution of the affected kidney was observed in 6 (15.8%) and 8 (21.1%) patients, respectively. There was no significant difference in the median involution time between the groups. The median time to involution in all patients was 36 months. CONCLUSIONS: Conservative management for a MCDK appears to be a safe option. Because of a complex MCDK has a high incidence of UTI, prophylactic antibiotics may be required. We recommend the long-term follow-up of a MCDK using ultrasonography monitoring.

A Case of Low-Grade Tubular-Mucinous Renal Neoplasm (LGTMRN) / 대한비뇨기과학회지

A low-grade tubular-mucinous renal neoplasm (LGTMRN) is a recently established renal tumor, which was thought to be of collecting duct origin. A 43-year-old man presented with acute abdominal pain and underwent abdominopelvic computed tomography (CT). The CT scan showed a 5cm sized low contrast attenuated homogeneous renal mass in the mid portion of the left kidney. A left radical nephrectomy was performed and the cut-section revealed a well-demarcated, homogeneous and dark-yellowish mass confined to the renal parenchyme, and a focal hemorrhage was also seen. A histological examination showed predominant tubular growth, with focal intraluminal and stromal mucin depositions and aggregates of foamy histiocytes. No infiltrative growth and significant nuclear atypia were found. These findings were compatible with a low-grade tubular-mucinous renal neoplasm.