Forgotten/retained double J ureteric stents: A source of severe morbidity in children.

BACKGROUND: The increase in the usage of double J (DJ) ureteral stents in the management of a variety of urinary tract disease processes mandates familiarity with these devices, their consequences and their potential complications, which at times can be devastating. We retrospectively reviewed our series of children with forgotten/retained DJ ureteric stents. MATERIALS AND METHODS: Hospital records of all patients' <18 years old who underwent removal of forgotten/retained DJ ureteral stent at our hospital were reviewed for age, gender, indication for insertion of DJ stent, duration of stent insertion, radiological images and surgical procedures performed. RESULTS: During the study period, January 2000 to December 2014 (a 15-year period), a total of 14 children underwent removal of forgotten/retained DJ ureteral stent. A combination of extracorporeal shock wave lithotripsy, cystolitholapaxy and percutaneous nephrolithotomy was done to free the DJ stent and extract it. CONCLUSIONS: Forgotten/retained stents in children are a source of severe morbidity, additional/unnecessary hospitalisation and definitely financial strain.

Type 2 diabetes mellitus and renal stones.

BACKGROUND: The incidence of urinary stone disease has shown a steep rise in recent decades along with marked modifications in dietary habits and life- style. There has been an increased prevalence of urinary stone disease in patients with diabetes. We took up this study to determine the association of diabetes mellitus with kidney stones in patients undergoing surgical treatment. MATERIALS AND METHODS: Patients presenting with renal stones for surgical management formed the study group. Body mass index (BMI) was calculated by noting the weight and height of the patient. The extracted stone/stone fragments were analyzed to determine the chemical composition. Urinary pH was similarly noted in all. RESULTS: The mean BMI among the diabetics was 26.35 ± 5.20 (range 17.75-35.60), whereas the mean BMI among the non-diabetics was 23.41 ± 2.85 (range 17.71-31.62) (P < 0.0004). The incidence of uric acid calculi in the diabetics was significantly high (P < 0.03). The mean urinary pH among the diabetics was 5.61 ± 0.36 and among the non-diabetics was 6.87 ± 0.32, which was significantly lower (P < 0.000044). CONCLUSIONS: There is a strong association between type 2 diabetes and uric acid stone formation. There is also a strong association between diabetes mellitus, BMI, and also with lower urinary pH.

Tumor doubling time of renal cell carcinoma measured by CT.

INTRODUCTION: Increasing numbers of patients are now being incidentally detected with small-sized renal cell carcinoma (RCC). The natural history of small renal masses is not completely understood. Currently, there are no specific tumor markers to determine initial risk or progression to metastatic disease. Growth rate and tumor size are factors shown to be predictive of tumor biology. In this study, we attempted to examine the natural history of RCC and calculated the doubling times (DTs) of untreated RCC at the primary site. MATERIALS AND METHODS: We retrospectively reviewed the records of all patients with RCC who had at least two measurements of the same tumor mass obtained on computed tomography (CT) imaging on two different dates (at least 6 months apart) during periods of non-treatment. The tumor volume was calculated at two points in time using images yielded by the CT imaging. The tumor DT was calculated using the following equation: DT = (T - T0) × log2/logV - logV0. RESULTS: Twenty-two (13 male and nine female) patients with ages ranging from 32 to 71 years (mean 52.22 years) were included in the study. The initial maximum tumor diameter ranged from 2.8 to 6.8 cm (mean 3.93 cm) and the last maximum tumor diameter ranged from 3.2 to 7.8 cm (mean 4.39 cm). The DT for the entire population was 460.01 days (range 174-913 days). CONCLUSIONS: RCC is a diverse disease process, with the majority of lesions demonstrating malignant disorder. In our study, the DT for the patient population was 460.01 days (range 174-913 days).

Penile growth in response to hormone treatment in children with micropenis.

INTRODUCTION: Micropenis is defined as a stretched penile length 2.5 standard deviations less than the mean for age without the presence of any other penile anomalies, such as hypospadias. The term refers to a specific disorder that has a known set of causative factors and defined treatment modalities. The purpose of this study was to determine the effect of hormonal therapy on the gonadal response and penile growth in children who presented with micropenis. MATERIALS AND METHODS: Children (<18 years) who met the criteria for micropenis were included in this study. Children more than 11 years old were treated using a standard protocol of 1,500 to 2,000 IU human chorionic gonadotrophin administrated intramuscularly, once per week, for 6 weeks. Children less than 11 years old were treated with parenteral testosterone enanthate 25 mg once a month for 3 months. Response was evaluated in terms of change in testosterone levels and size of penis. RESULTS: Serum testosterone levels at baseline and after 8 weeks of hormonal treatment were <20 and 449.4 ng/mL, respectively (P < 0.0001) in all children more than 11 years old. Stretched penile length after hormonal treatment increased from 15.54 to 37.18 mm in children less than 11 years old and from 26.42 to 64.28 mm in children more than 11 years old (P < 0.001). CONCLUSIONS: Management of isolated micropenis revolves around testosterone (direct administration or encouraging the patient's body to make its own), and results with respect to increase in penile length are promising.

Flexible ureteroscopy for upper ureteral calculi in children.

INTRODUCTION: Ureteroscopy is one of the therapeutic options in the management of urinary stone disease in children. Previous literature has described ureteroscopy primarily in mid to distal ureteral calculi. We report our experience with flexible ureteroscopy in the management of upper ureteral calculi. PATIENTS AND METHODS: All children with upper ureteral stones were included prospectively in the study. Stone burden was measured in millimeters. Presentation, operative access, intraoperative complications, stone-free rates, and postoperative complications were evaluated. RESULTS: A total of 80 children (69 boys and 11 girls) underwent 88 ureteroscopic procedures. In 72 (90%) children, complete stone clearance was achieved after a single ureteroscopic session. In 6 (7.5%) others, complete stone clearance was achieved after the second ureteroscopic session. CONCLUSIONS: Complete stone clearance after single ureteroscopy is possible if the calculi are single, small (<10 mm), and below the level of the pelviureteral junction.

Laparoscopic hemi/partial nephrectomy in children with ureteral duplication anomalies.

INTRODUCTION: Recent advances in laparoscopic surgery as well as increasing experience with these techniques have led to the selection of laparoscopic surgery for hemi/partial nephroureterectomy in children with a non/poorly functioning moiety in a duplex kidney. There is very little data on the long term follow-up of such children. We report our experience of laparoscopic hemi-nephroureterectomy in children with duplex moiety. MATERIALS AND METHODS: We retrospectively reviewed the case records of children undergoing laparoscopic partial/hemi nephroureterectomy. Demographic data, age, weight, diagnosis, type of operation, operative time, concomitant and subsequent procedures, blood loss, use of drains, analgesic requirement, length of hospitalization and complications were recorded. RESULTS: 29 children (21 girls and 8 boys) underwent laparoscopic hemi/partial nephrectomy. The median operative time was 94 min (range 68-146 min). The mean blood loss was 25 ml and no children required perioperative blood transfusion. CONCLUSIONS: Laparoscopic hemi/partial nephrectomy in children is safe, associated with decreased morbidity and shorter hospitalization. Long term follow-up is necessary to study long term outcomes.