ABSTRACT
Calcium nephrolithiasis in children is increasing in prevalence and tends to be recurrent. Although children have a lower incidence of nephrolithiasis than adults, its etiology in children is less well understood; hence, treatments targeted for adults may not be optimal in children. To better understand metabolic abnormalities in stone-forming children, we compared chemical measurements and the crystallization properties of 24-h urine collections from 129 stone formers matched to 105 non-stone-forming siblings and 183 normal, healthy children with no family history of stones, all aged 6 to 17 years. The principal risk factor for calcium stone formation was hypercalciuria. Stone formers have strikingly higher calcium excretion along with high supersaturation for calcium oxalate and calcium phosphate, and a reduced distance between the upper limit of metastability and supersaturation for calcium phosphate, indicating increased risk of calcium phosphate crystallization. Other differences in urine chemistry that exist between adult stone formers and normal individuals such as hyperoxaluria, hypocitraturia, abnormal urine pH, and low urine volume were not found in these children. Hence, hypercalciuria and a reduction in the gap between calcium phosphate upper limit of metastability and supersaturation are crucial determinants of stone risk. This highlights the importance of managing hypercalciuria in children with calcium stones.
Subject(s)
Calcium Oxalate/urine , Calcium Phosphates/urine , Calcium/urine , Hypercalciuria/complications , Kidney Calculi/etiology , Siblings , Adolescent , Age Factors , Biomarkers/blood , Case-Control Studies , Child , Crystallization , Female , Genetic Predisposition to Disease , Humans , Hypercalciuria/genetics , Hypercalciuria/urine , Kidney Calculi/genetics , Kidney Calculi/urine , Linear Models , Male , Risk Assessment , Risk Factors , United StatesABSTRACT
Seminal vesicle cysts associated with other genitourologic abnormalities are rare. We describe the first known robot-assisted excision of a cystic seminal vesicle associated with ipsilateral renal agenesis in a symptomatic pediatric patient. The patient was discharged home on postoperative day 1 and remains symptom free after 9 months' follow-up. Operative time, blood loss, and hospital stay were comparable to those of published series of conventional laparoscopy.
Subject(s)
Cysts/complications , Cysts/surgery , Kidney/abnormalities , Robotics/instrumentation , Seminal Vesicles/pathology , Seminal Vesicles/surgery , Adolescent , Cysts/diagnostic imaging , Humans , Male , Seminal Vesicles/diagnostic imaging , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Persistent müllerian duct syndrome (PMDS) is a rare form of male pseudohermaphroditism. Bilateral fallopian tubes and a uterus occur with an otherwise normal male phenotype. Testicular neoplasm in PMDS has been reported, but malignant degeneration of the remnant female genitalia has only once been reported. We present imaging, surgical specimen, and surgical pathology of the first documented case of uterine adenosarcoma of a müllerian remnant in a 14-year-old boy with PMDS presenting with gross hematuria and increasing abdominal protuberance. The child died of metastatic disease after surgical resection.
