Management of pediatric vanishing testes syndrome based on pathological diagnosis: a single-center retrospective study.

This study aims to explore the optimal management strategy for pediatric vanishing testes syndrome (VTS) based on pathological characteristics. We retrospectively analyzed clinical data and pathological results of children with unilateral VTS who underwent surgical treatment at our center from July 2012 to July 2023. The children were categorized into the testicular excision group and testicular preservation group based on the surgical approach. Clinical characteristics and outcomes were compared between the two groups. Pathological examination results of excised testicular tissues were collected and analyzed, and long-term follow-up was conducted. A total of 368 children were included in this study. The age of the children at the time of surgery was 27 months (range, 6-156). Among them, 267 cases (72.6%) had VTS on the left side, and 101 cases (27.4%) on the right side. There were no statistically significant differences (P > 0.05) in age, affected side, contralateral testicular hypertrophy (CTH), testicular location, and preferred surgical incision between the testicular excision group (n = 336) and the testicular preservation group (n = 32). In the preservation group, two children experienced scrotal incision infections, showing a statistically significant difference compared to the excision group (P < 0.05). Pathological examination of excised tissues revealed fibrosis as the most common finding (79.5%), followed by vas deferens involvement (67%), epididymis involvement (40.5%), calcification (38.4%), and hemosiderin deposition (17.9%). Seminiferous tubules (SNT) was present in 24 cases (7.1%), germ cells (GC)in 15 cases (4.5%), and ectopic adrenal cortical tissue(EACT) in 1 case (0.3%). VTS belongs to a type of non-palpable testes (NPT) and requires surgical exploration. Considering the risk of scrotal incision infection after preserving atrophic testicular remnants and the unpredictable malignant potential, we recommend excision.

Diagnosis and treatment strategies for pediatric urogenital tract foreign bodies: A retrospective study.

BACKGROUND: Foreign bodies in the pediatric urogenital tract are rare but urgent clinical conditions that can cause severe symptoms and complications. The current management remains challenging. OBJECTIVE: This study aims to provide an in-depth understanding of the clinical characteristics, diagnostic challenges, and treatment strategies for pediatric urogenital tract foreign bodies. Through a retrospective analysis of patient data, valuable insights into the management of this condition are offered to facilitate the development of more effective management strategies. METHODS: A single-center retrospective study design was employed, reviewing clinical data of 30 pediatric patients with urogenital tract foreign bodies admitted to Anhui Children's Hospital from October 2016 to May 2023. This included 16 cases of urethral and bladder foreign bodies and 14 cases of vaginal foreign bodies. Among them, there were 14 males and 16 females, with a median age of 6.3 years. Treatment methods included transvaginal endoscopic removal, cystoscopic removal, pneumovesicum laparoscopy removal, and perineal incisional foreign body removal. Surgical time, blood loss, hospitalization days, and postoperative follow-up results were recorded. RESULTS: Key clinical presentations included vaginal bleeding, abnormal vaginal discharge, hematuria, dysuria, urinary retention, and perineal pain. Preoperative routine examinations included ultrasound, abdominal radiography, and, in some cases, CT scans. All 30 patients underwent successful surgery, with a median surgical time of 30.5 min (IQR 16.8-50.8), minimal intraoperative bleeding, and a median postoperative hospital stay of 2 days (IQR 2-3). Follow-up from 3 months to 1 year revealed no abnormalities in the urogenital system, no residual foreign bodies, and no occurrence of severe complications. No cases of recurrent foreign body insertion were observed. CONCLUSION: Early diagnosis and treatment of pediatric urogenital tract foreign bodies are crucial to reduce patient suffering and the risk of complications. The choice of surgical method depends on the type, size, and location of the foreign body, with endoscopy being the preferred option. Laparoscopic cystoscopy and open surgery are also effective treatment modalities.

Analysis of the Therapeutic Efficacy of Laparoscopic Treatment for Fibroepithelial Polyps of the Ureter in Children.

Objective: The aim of this study is to assess the efficacy and safety of laparoscopic surgery in the treatment of pediatric ureteral fibroepithelial polyp (FEP) patients. Our hypothesis is that laparoscopic surgery can effectively treat FEPs while minimizing patient discomfort and complications. Our research aims to evaluate the clinical outcomes of the surgery, including postoperative symptom relief, improvement in kidney function, and risk of postoperative complications. Methods: The clinical records of 34 patients who underwent ureteral polyp surgery at the Department of Urology at Anhui Provincial Children's Hospital between May 2014 and February 2023 were retrospectively analyzed. All patients underwent laparoscopic surgery. Among the 34 pediatric patients, there were 31 males and 3 females, with 2 on the right side and 32 on the left side. Of these cases, 24 polyps were located at the ureteropelvic junction, while seven were found in the upper segment of the ureter and three in its middle segment. Patients' ages ranged from 4 years and 3 months to 15 years, with a median age of 8 years and 6 months. All children presented with varying degrees of hydronephrosis, and preoperative clinical symptoms included ipsilateral flank or abdominal pain, hematuria, and other discomfort. Preoperative examinations mainly comprised ultrasound, intravenous pyelography, CT, or magnetic resonance urography imaging studies, as well as diuretic renography. All pediatric patients underwent laparoscopic excision of the polyp segment of the ureter, followed by renal pelvis ureteroplasty or ureter-to-ureter anastomosis. Results: All patients underwent surgery without conversion to open surgery. The surgical duration ranged from 72 to 313 minutes, with an average of 179.5 minutes. The average intraoperative blood loss was 14 mL. Postoperatively, one patient experienced leakage at the anastomotic site; however, no other significant complications occurred during or after the procedure. Postoperative histopathology confirmed the presence of FEPs in the ureter for all cases. All patients experienced a favorable postoperative recovery, with hospitalization periods ranging from 3 to 16 days and an average stay of 8.6 days. A Double-J stent was inserted in all patients for a duration of 1 to 2 months after surgery, and upon removal, follow-up color Doppler ultrasound revealed reduced hydronephrosis within 1 to 3 months. Follow-up examinations were conducted at intervals ranging from 3 to 108 months postsurgery, with an average follow-up time of 42.2 months, during which no recurrence of ureteral polyps or symptoms such as pain and hematuria was observed. Conclusions: The findings of this study demonstrate that laparoscopic excision of the polyp segment of the ureter, renal pelvis ureteroplasty, and ureter-to-ureter anastomosis represent safe and effective treatment modalities for pediatric FEPs in the ureters. This technique offers several advantages, including minimal invasiveness, rapid recovery, and definitive therapeutic efficacy, which effectively alleviate clinical symptoms and improve hydronephrosis.

Laparoscopic-Assisted Scrotal Approach for the Treatment of Inguinal Cryptorchidism with Patent Processus Vaginalis: Clinical Efficacy Analysis.

Objective: This study aimed to compare the clinical outcomes of two surgical approaches, laparoscopic-assisted scrotal incision and conventional inguinal-scrotal incision, for treating cryptorchidism with unobliterated processus vaginalis. Methods: Clinical data from 60 pediatric patients with inguinal cryptorchidism who were admitted to our institution between January 2018 and January 2022 were retrospectively analyzed. Depending on the surgical technique used, the patients were split into two groups: the laparoscopic group (n = 30) underwent a laparoscopic-assisted scrotal incision, whereas the conventional group (n = 30) underwent a conventional inguinal-scrotal incision for testicular descent and fixation. The length of the procedure, intraoperative blood loss, and the typical hospital stay following the procedure were compared between the two groups. Also assessed was the frequency of postoperative complications including wound infection and hematoma development. Results: The laparoscopic group demonstrated a notably shortened average surgical duration compared with the traditional group, and this discrepancy held statistical significance (P = .017). Moreover, the laparoscopic approach resulted in a reduced volume of intraoperative blood loss, with a statistically significant distinction (P = .002), along with a decreased average length of hospital stay after surgery, also statistically significant (P = .009). Testicular retraction, atrophy, inguinal hernias, or hydrocele were not present in any group. Although the difference between the laparoscopic and open groups was not statistically significant (P > .05), the laparoscopic group saw a reduced frequency of scrotal hematoma. The frequency of wound infection was also decreased in the laparoscopic group compared with the open group, although there was no statistically significant difference (P > .05). Conclusion: The laparoscopic-assisted scrotal incision approach for testicular descent and fixation offers precise localization of cryptorchidism, reduced surgical trauma, shorter postoperative recovery time, and results in smaller scars with minimal tissue damage. The procedure showcases enhanced overall clinical effectiveness, fewer postoperative complications, heightened safety, and superior cosmetic outcomes.

The diagnosis and treatment of testicular torsion in children with non-scrotal initial symptoms.

Objective: To explore the clinical characteristics of testicular torsion in children with non-scrotal initial symptoms who were misdiagnosed. Methods: A retrospective analysis of 73 cases children with testicular torsion and non-scrotal symptoms who were admitted to our department from October 2013 to December 2021 was performed. Patients were divided into misdiagnosis (27 cases) and clear diagnosis at first visit (46 cases) groups. Clinical data, including age at surgery, clinical presentation, physical examination, number of visits (≥2 times), affected side, time from initial symptoms to surgery, and surgical outcomes, were collected. The TWIST (Testicular Workup for Ischemia and Suspected Torsion) score was calculated and analyzed. Results: Statistically significant differences between the misdiagnosis and clear diagnosis groups were seen in the time from initial symptoms to surgery, the number of visits, the degree of testicular torsion, and the rate of orchiectomy (P < 0.05). There were no statistically significant differences (P > 0.05) in age, affected side, TWIST score, guardian, direction of testicular torsion, intra-vaginal or extra-vaginal torsion, and Arda classification. Postoperative follow-up was 6-40 months. Of the 36 patients who required an orchiopexy, 1 had testicular atrophy at six months and 2 were lost to follow-up. The contralateral testis of the 37 children who underwent orchiectomies developed normally without torsion. Conclusions: The clinical manifestations of testicular torsion in children are diverse and can easily lead to misdiagnosis. Guardians should be aware of this pathology and seek timely medical attention. When the initial diagnosis and treatment of testicular torsion is difficult, the TWIST score during the physical examination may be useful, especially for patients with intermediate-to-high risk scores. Color Doppler ultrasound can assist in making the diagnosis, but when testicular torsion is highly suspected, routine ultrasound is not necessary as it may lead to delayed surgical treatment.

A Single-Center Study of the Efficacy of Transvesicoscopic Ureterovesical Reimplantation: With or Without Ureteral Tailoring in Children with Congenital Megaureter.

Objective: To investigate the efficacy of ureteral tailoring with or without ureteral bladder reimplantation in the treatment of primary megaureter (MGU) in children by transvesicoscopic ureteral reimplantation. Methods: Clinical data from 21 children with primary MGU who were treated with pneumo-bladder ureterovesical reimplantation in Anhui Children's Hospital from January 2019 to August 2022 were retrospectively analyzed. Thereafter, children were divided into two groups according to whether intraoperative ureteral tailoring was performed, including 9 in the trimmed group and 12 in the nontrimmed group. In the meantime, there were 16 males and 5 females, with the age of 4.7 ± 2.12 years. Furthermore, there were 17 obstructive MGU cases, 2 reflux MGU cases, and 2 obstructive with reflux MGU cases, with 16 cases on the left side (including 1 case of Y-shaped ureter in the left duplicated kidney), whereas 5 on the right side. All children underwent transvesicoscopic ureteral reimplantation (the Cohen procedure). Thereafter, changes in operation time, duration of retained catheterization, hematuria time, renal pelvis and ureteral dilatation, and tortuosity between two groups were compared 3 months after Double-J tube removal. Results: All children were effectively treated with transvesicoscopic ureteral reimplantation, the operation time (p = 0.02, p < 0.05), postoperative hematuria time (p = 0.00, p < 0.05), and retained urinary catheter time (p = 0.00, p < 0.05) were shorter in the nontrimmed group, and the mean postoperative follow-up time was 27.6 (3-22) months. Moreover, the postoperative anteroposterior diameters of the affected renal pelvis in both groups were 0.31 ± 0.39 cm and 0.27 ± 0.29 cm, respectively, whereas the postoperative maximum ureteral diameters were 0.33 ± 0.31 cm and 0.27 ± 0.36 cm, separately, which were significantly reduced compared with the preoperative counterparts. All children recovered well, with no postoperative complications. Conclusion: Whether intraoperative ureteral clipping is performed or not does not significantly affect the outcome of transvesicoscopic laparoscopic ureteral bladder reimplantation for primary MGU in children. Both groups of children improved with satisfactory surgical results, but the nontrimmed group has shorter operation time, simpler operation, and less trauma.

[Traversing the vertical pedicle flap for the treatment of severely buried penis in children].

OBJECTIVE: To assess the effect of traversing the vertical pedicle flap (TVPF) for the treatment of severely buried penis in children. METHODS: Totally 43 children with severely buried penis underwentTVPF (n = 21)or modifiedShiraki surgery (control, n = 22) in our hospitalfrom February to December 2014. Wecompared the operation time, intra-operation blood loss, foreskin swelling time, and parents' satisfaction with penile appearance between the two groups. RESULTS: No statistically significant differences were observed between the TVPFand control groups in the operation time (ï¼»45.0 ±6.8ï¼½ vs ï¼»42.0 ±5.3ï¼½ min, P>0.05) or intra-operation blood loss(ï¼»5.0 ±1.2ï¼½ vs ï¼»6.0 ±0.8ï¼½ ml, P>0.05). The average foreskin swelling time was markedly shorter in the TVPFgroup than in the control (ï¼»9.0 ±2.3ï¼½ vs ï¼»15.0 ±4.8ï¼½ d, P<0.05)and the parents' satisfaction with penile appearancewas higher in the former than in the latter (95.23vs31.81 %, P<0.05). The elastic bandages were removedfor all the patientsat 3 days postoperatively, and 3 to 6-month follow-up revealed no penile retraction or relapse. CONCLUSIONS: The method of traversing the vertical pedicle flap is a feasible surgical option for the treatment of severely buried penis in children, which can make a rational use of the foreskin,remove the tight ring, and achieve a satisfactory appearance of the penis.