ABSTRACT
INTRODUCTION AND IMPORTANCE: Wilms tumor (WT), a prevalent pediatric renal malignancy (7 %), frequently intertwines with genitourinary anomalies. This unique report presents a case of WT combined with horseshoe Kidney and an extending atrial thrombus, emphasizing critical management considerations. CASE PRESENTATION: A 3-year-old boy, experiencing flank pain and weight loss, manifested a WT linked to horseshoe Kidney, accompanied by an atrial thrombus. Neoadjuvant chemotherapy downsized the tumor and thrombus, enabling successful surgical intervention. Post-surgery, 27 weeks of adjuvant chemotherapy were administered. Over three years, follow-up exhibited renal recovery, no recurrence, and clear CT scans. DISCUSSION: Prompt identification, precise imaging (via CT angiography), and multidisciplinary care are pivotal for managing WT in horseshoe Kidney cases. Preoperative chemotherapy notably reduced tumor and thrombus sizes, enhancing surgical feasibility. Long-term vigilance is essential for recurrence and treatment-related complications. CONCLUSION: Effectively managing WT in horseshoe Kidneys demands timely recognition, meticulous imaging, and collaborative management. Successful outcomes highlight preoperative chemotherapy's benefits and underscore extended monitoring's significance in confirming sustained recovery.
ABSTRACT
Background Urinary tract infections (UTIs) are common in patients with diabetes. The use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) to achieve good glycemic control increases glucose levels in urine. This glycosuria further enhances the risk of UTIs. This study aimed to evaluate the frequency of UTIs in patients with type 2 diabetes receiving the SGLT2i dapagliflozin as an add-on therapy. Methods We conducted this cross-sectional study at the Endocrinology Department of Hayatabad Medical Complex in Peshawar from April 2020 to September 2020. A total of 400 patients with diabetes receiving either 5 mg or 10 mg of dapagliflozin as an add-on therapy for the treatment of type 2 diabetes were included in this study. We collected blood and urine samples from participants and measured glycosylated hemoglobin levels. Urine samples were cultured on cysteine lactose electrolyte deficient agar. We used IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, NY) to analyze our data. Results The prevalence of UTIs in diabetic patients receiving 5 mg or 10 mg of dapagliflozin was 5.3%. Women were more affected (76.2%) than men (p < 0.05). UTIs were more prevalent in patients older than 50 years (85.7%) than in any other age group. The dose strength of dapagliflozin was not associated with UTIs (p > 0.05). Conclusion This study examined UTIs in patients taking dapagliflozin for the treatment of type 2 diabetes. These infections were mild to moderate and were treated easily. None of these infections caused the patient to discontinue the treatment. Dapagliflozin is well-tolerated in patients with diabetes but should be used with appropriate caution and monitoring.
ABSTRACT
OBJECTIVE: To report the outcomes of operative management of traumatic posterior urethral distraction defect in boys at our Centre, as traumatic posterior urethral stricture in children is a rare condition that presents a major surgical challenge to the paediatric urologist and consensus on the optimal treatment of these strictures in children has not been reached. PATIENTS AND METHODS: We retrospectively analysed our data from July 2013 to June 2018. All boys aged ≤16 years with traumatic posterior bulbo-prostatic obliteration (distraction defect) were included. Initial suprapubic cystostomy and delayed definite anastomotic urethroplasty was done in all the boys. The boys were evaluated preoperatively with a retrograde urethrogram and simultaneous voiding cystourethrogram, as well as cystourethroscopy. RESULTS: A total of 38 boys, with posterior urethral distraction defect, were divided into primary and redo surgery groups. The primary group comprised 34 boys who were operated upon for the first time. A perineal approach with development of an inter-crural space was done in 12 boys and along with an inferior pubectomy in 19 boys. Three boys in the primary group needed a transpubic approach due to a longer defect. In the redo group, there were six boys, of which four were operated initially outside our hospital, while two were our own unsuccessful urethroplasties. In the redo group, a perineal approach with inferior pubectomy was done in two boys and a transpubic urethroplasty in the remaining four boys. The success rate of anastomotic urethroplasty without any ancillary procedures was 81.5% (strict criterion), while the overall success rate was 94.7% (permissible criterion, which included boys who were managed later with direct vision internal urethrotomy and dilatation). CONCLUSION: The ideal treatment of post-traumatic posterior urethral defect/strictures in boys is tension-free bulbo-prostatic anastomosis. This was done using a transperineal approach in most of the boys, but a few required a transpubic approach, with good results. ABBREVIATIONS: DVIU: direct vision internal urethrotomy; SPC: suprapubic cystostomy; SUI: stress urinary incontinence.
