Management of lower urinary tract fibroepithelial polyps in children.

INTRODUCTION: Fibroepithelial polyps (FEP) of the lower urinary tract are relatively common in adults but rare in children, with fewer than 250 cases reported in the literature to date. OBJECTIVE: The aim of this study was to address the experience of FEP management in children. STUDY DESIGN: A retrospective multicenter review was undertaken in children with defined FEP of the lower urinary tract managed between 2008 and 2018. The data at 18 pediatric surgery centers were collected. Their demographic, radiological, surgical, and pathological information were reviewed. RESULTS: A total of 33 children (26 boys; 7 girls) were treated for FEP of the lower urinary tract at 13 centers. The most common presentation was urinary outflow as hematuria (41%), acute urinary retention (25%), dysuria (19%), or urinary infections (28%). A prenatal diagnosis was made for three patients with hydronephrosis. Almost all of the children (94%) underwent ultrasound imaging of the urinary tract as the first diagnostic examination, 23 (70%) of them also either had an MRI (15%), cystourethrography (25%), computerized tomography (6%), or cystoscopy (45%). Two of these children (6%) had a biopsy prior to the surgery. The median preoperative delay was 7.52 (range: 1-48) months. Most of the patients were treated endoscopically, although four (12.1%) had open surgery and two (6.1%) had an additional incision for specimen extraction. The median hospital stay was 1.5 (range: 1-10) days. There were no recurrences and no complications after a median follow-up of 13 (range: 1-34) months. DISCUSSION: The main limitation of our study is the retrospective design, although it is the largest one for this pathology. CONCLUSION: This series supports sonography as the most suitable diagnosis tool before endoscopy to confirm the diagnosis and to perform the resection for most FEP in children. This report confirms the recognized benign nature in the absence of recurrences. LEVEL OF EVIDENCE: Level V.

Pyloric Mucosal Diaphragm Associated with Hypertrophic Pyloric Stenosis: An Unusual Combination in a Male Neonate.

We describe herein the case of a 3-week-old baby with persistent nonbilious vomiting, due to a hypertrophic pyloric stenosis (HPS) associated with a congenital pyloric mucosal diaphragm. So far, an association between the two conditions has not been described. The diagnosis of a pyloric mucosal diaphragm was delayed because of its cooccurrence with HPS.

Use of Nonabsorbable Spiral Tacks for Mesh Reinforcement in Thoracoscopic Repair of Congenital Diaphragmatic Hernia.

Thoracoscopic prosthetic repair of congenital diaphragmatic hernia (CDH) is a well-established and safe technique in experienced hands but the patching procedure is technically demanding and time consuming. To address the challenges associated with this process (confined working space and restricted time), the aim of this article is to assess the potential improvements in feasibility, efficacy, and safety of patch fixation by using nonabsorbable helicoidal tacks in neonates and infants for the repair of large CDH by thoracoscopy. The new technique has all the advantages of minimal invasive surgery in very young children combined with the advantages of reduced operating time and increased simplicity, and may be a good option in cases of recurrence.

Open versus Thoracoscopic RFA-Assisted Lung Resection.

The purpose of this study was to evaluate Radio Frequency Ablation (RFA)-assisted lung parenchymal transection through thoracotomy and thoracoscopy. Twelve domestic pigs underwent RFA-assisted lingulectomy: six through thoracotomy (group A), and six with thoracoscopy (group B). There was no mortality, no bleeding, or air leak intra- or postoperatively in either of the groups, and no conversion to open thoracotomy in group B. Group A had longer operating period and more pleural adhesions. A barotrauma, a skin burn, and a localized infection were observed in this group. Histopathology confirmed a sharply demarcated area of coagulation necrosis without damage to adjacent structures. RFA-assisted lung resection through thoracotomy bears the inherent problems of an open approach, and the use of RFA device does not add to morbidity. The thoracoscopic use of RFA probe by experienced surgeons is considered safe, maintaining the advantages of key-hole surgery.

Aortic bypass and bilateral renal autotransplantation for mid-aortic syndrome.

BACKGROUND: Middle aortic syndrome (MAS) is a rare condition characterized by stenosis of the proximal abdominal aorta and the origin of the renal and digestive arteries. When medical therapy and interventional radiology fail to control threatening reno-vascular arterial hypertension (AHT), surgery is required and may need several interventions, which are usually delayed until late childhood. CASE: We report on a 3-year-old girl with severe AHT (180/130 mmHg) caused by MAS. There was no evidence of generalized vascular disease or complications of AHT. AHT failed to respond to medical therapy (five drugs), endovascular dilatation, and stenting was considered unfeasible due to the complex multiple strictures. Surgery consisted of: explantation of the two kidneys; aortic bypass between the lower thoracic and lower abdominal aorta using a prosthetic graft; reimplantation of the kidneys onto the normal iliac arteries. The post-operative course was uneventful. Owing to recurrent stenosis of the re-implanted renal arteries, endoluminal dilatations were performed 4 and 5 months after surgery. Two years after surgery, the child is alive and well, off anti-hypertensive therapy, with normal blood pressure. CONCLUSION: Mild aortic syndrome can be treated with a one-stage surgical repair with aorto-aortic bypass and bilateral auto-transplantation, even in young children.

A case of cystic dysplasia of the rete testis in a 17-months-old boy.

Cystic dysplasia of the testis (CDT) is a benign, congenital malformation of the testis and a rare cause of painless scrotal swelling in children, mimicking testicular cancer. It is commonly unilateral, often associated with ipsilateral wolffian duct and ureteral abnormalities. Cystic dysplasia of the rete testis (CDT) represents a diagnostic challenge made easier if age, precise localisation, typical ultrasonographic features, the presence or absence of associated genitourinary malformations, as well as tumor markers are considered. The definite treatment of such a benign lesion is testis-sparing surgery, however in most cases watch and wait strategy can be recommended. We present a case of cystic dysplasia of the testis in a 17-month-old boy with right multicystic dysplastic kidney, epididymal cyst, history of vesicoureteral reflux (VUR), as well as of solitary umbilical artery. We performed epididymidal cyst enucleation and right testicular biopsy.

Video-assisted lung resection using radiofrequency ablation in a porcine model.

BACKGROUND: The aim of this study was to assess the feasibility, efficacy, and safety of video-assisted lingula resection using radiofrequency ablation (RFA) with internally cooled electrodes in a porcine model. MATERIALS AND METHODS: Six domestic pigs underwent RFA-assisted thoracoscopic lingulectomy. RFA was the only aerostatic and hemostatic method applied throughout the operation. After 30 d, the animals were sacrificed for the study of the macroscopic and microscopic effects of the technique. RESULTS: No signs of pneumothorax, blood loss, or infection were observed up to 1 mo postoperatively. There was no mortality either during or after surgery. The histopathology of the lung revealed three clearly demarcated zone lesions. CONCLUSIONS: Our study demonstrates that thoracoscopic lingulectomy using RFA energy is technically feasible. RFA energy is an effective and safe aerostatic and hemostatic method in the porcine model.