Retrospective Review of Pediatric Blunt Renal Trauma: A Single Institution's Five Year Experience.

Children are at higher risk of renal injury from blunt trauma than adults due to a variety of anatomic factors such as decreased perirenal fat, weaker abdominal muscles, and a less ossified thoracic cage. Non-operative management is gaining in popularity for even major injuries, although there are no universally accepted guidelines. We present a retrospective review of pediatric major blunt renal injuries (grade 3 or higher) at a children's hospital in Hawai'i over a 5-year period. Medical records were examined between January 2009 and September 2014 from Kapi'olani Medical Center for Women and Children in Honolulu, Hawai'i. Inclusion criteria were a diagnosis of renal trauma, or the diagnosis of blunt abdominal trauma with hematuria. Exclusion criteria were grade I or II renal injury or death due to an additional traumatic injury. Mechanism of injury, clinical characteristics on admission, blood product requirements, surgical interventions performed, and hospital length of stay were retrospectively analyzed. Eleven total patient records were examined, nine of which fit inclusion criteria. Uniquely, 33% of patients sustained their renal injury while surfing. No patients required laparotomy or nephrectomy, though 22% of patients received a blood transfusion and 44% of patients underwent ureteral stent placement. Non-operative management of major renal injuries in children is feasible and allows for preservation of renal tissue. A novel mechanism of surfing as a cause of major renal trauma is seen in the state of Hawai'i.

Testicular teratoma with nephroblastoma component.

We report the development of Wilms' tumor in an atrophic testis and review the potential molecular pathogenesis. An 18-year-old man presented with 2 days of right testicular pain and growth in his atrophic testis. Ultrasonography revealed a heterogeneous mass. The chest radiographic findings and testicular tumor marker levels were normal. He underwent radical orchiectomy, with the pathologic examination showing teratoma with a nephroblastoma component, focal embryonal carcinoma, and minute yolk sac tumor. The development of Wilms' tumor in the testis is rare and can be explained by the activation of the WT1 gene during embryogenesis.

Collecting duct carcinoma arising from multicystic dysplastic kidney disease.

Malignancy arising from a multicystic dysplastic kidney (MCDK) is rare. Most reports are of Wilms' tumor and clear-cell renal cell carcinoma arising from a previously unrecognized MCDK. To our knowledge, no reports have described collecting duct carcinoma arising from MCDK.

Nonoperative management of a patent urachus.

Patent urachus accounts for 10% to 15% of all reported urachal abnormalities in the literature. Treatment in the past has relied on immediate surgery. Conservative therapy with bladder catheter drainage, resulting in spontaneous closure, has not been described. We report a case of patent urachus in a 6-day-old infant who presented with urine drainage from the umbilicus. Radiographic studies confirmed a patent urachus. One week of urethral catheterization resulted in spontaneous closure of the patent urachus. This case suggests that initial treatment should consist of urethral catheterization for 1 to 2 weeks, followed by repeat voiding cystourethrogram. If the patent urachus still persists, one should proceed to surgical correction.

Prenatal intervention for urinary obstruction and myelomeningocele

Widespread use of ultrasonography has resulted in an increase in the recognition of fetal hydronephrosis. The enthusiasm that accompanied early interventions has been tempered by the experience and results obtained over the past 2 decades. The goal has remained the same: to identify patients with serious prenatal obstruction and to identify those which may benefit from intervention. Myelomeningocele remains a devastating congenital anomaly. Fetal and experimental studies suggested that patients with myelomeningocele could benefit from prenatal intervention. Advances in technology and perinatal management have made intervention for more complex malformations such as myelomeningocele possible. This article will review current knowledge and will detail rational management for the management of prenatal hydronephrosis. The current state of antenatal myelomeningocele repair and the urologic implications will be described as well.

Prenatal intervention for urinary obstruction and myelomeningocele.

Widespread use of ultrasonography has resulted in an increase in the recognition of fetal hydronephrosis. The enthusiasm that accompanied early interventions has been tempered by the experience and results obtained over the past 2 decades. The goal has remained the same: to identify patients with serious prenatal obstruction and to identify those which may benefit from intervention. Myelomeningocele remains a devastating congenital anomaly. Fetal and experimental studies suggested that patients with myelomeningocele could benefit from prenatal intervention. Advances in technology and perinatal management have made intervention for more complex malformations such as myelomeningocele possible. This article will review current knowledge and will detail rational management for the management of prenatal hydronephrosis. The current state of antenatal myelomeningocele repair and the urologic implications will be described as well.