Posterior urethral valves: varied presentations and outcome after preliminary surgical treatment

To find out various modes of presentation and outcome after preliminary surgical treatment of posterior urethral valves in pediatric population. Surgical Unit B National Institute of Child Health, Karachi, during the years 2004-2005. All consecutive patients coming in outpatient / emergency departments, diagnosed as having posterior urethral valves and those who had received initial treatment and came for follow up, were included in the study. All the neonates underwent vesicostomy initially, followed by valve ablation at appropriate age with plan for undiversion at later date. In infants valve ablation was performed if urethral size admitted pediatric cystoscope while older children underwent primary valve ablation. There were total of 22 patients managed during the study period. They included 5 neonates [0-1 month], 11 infants [1-12 months] and 6 older children [1year-12 years]. The main presenting complaint in majority of neonates was inability to pass urine and one had urinary ascites. Infants presented mainly with either difficulty in passing urine [n 5] or dribbling and acute urinary retention in 2 patients each. Majority of older children [n 3] presented with poor urinary stream and dribbling while two had diurnal enuresis and one came with straining at micturition. In all the neonates' vesicostomy was performed. Out of these 3 received valve ablation therapy, followed by undiversion. Two of them improved while 1 had bladder dysfunction. Of the remaining 2 patients with vesicostomy 1 is still waiting for definitive procedure while the other is lost to follow up. Of infant group, 8 were subjected to vesicostomy and valves ablated at later stage whereas 2 received primary valve fulguration therapy. One patient of this group died before any intervention performed. In older age group, 3 received valve ablation as initial treatment while 3 were lost to follow up before any intervention. Outcome assessed clinically, biochemically and radiologically. Out of total 22, four had not received any intervention. Of the remaining 18, treatment completed in 12 patients, 8 of these improved and 4 had residual disease. Two patients expired and 4 were lost to follow up. The overall improvement rate observed at the end of our study was 44%. In 22% patients there were still residual ongoing problems that need to be addressed on long term basis

Childhood nephrectomies for benign renal lesions

To conduct an audit of nephrectomies done in children for benign renal pathology. Evidence based study. Place and Duration: National Institute of Child Health, Karachi, during the year 2004-2005. The record of all the paediatric age group patients undergoing unilateral nephrectomy for benign renal diseases over a 2-year period were reviewed for the underlying diagnosis and indication for nephrectomy. Patients of Wilms` tumor subjected to nephrectomy were excluded. In the study nephrectomy was carried out in a total of 12 patients. There were 8 males and 4 females. The age range was 4 to 12 years. Nephrectomy was performed for renal tuberculosis in 5, pelvi-ureteric junction obstruction [PUJO] in 5, congenital hypoplastic kidney in 1 and one for multicystic dysplastic kidney. All the patients following nephrectomy remained well in the immediate post operative period and thereafter. Late presentation and delay in diagnosis of benign lesions of the kidney remained the main culprit in loosing a vital organ in childhood

Neonatal intussusception: a rare entity

Intussusception is a common cause of intestinal obstruction in infancy. It has been reported in pre-matures and during fetal life as well. In full term neonates it is a rare entity. In this case report we describe our experience of management of a six days old male baby. Who turned out to be a case of idiopathic ileoileal intussusception. As the gut was non viable, resection and anastomosis were performed. Post operative recovery were uneventful