Nephroblastoma with Right Atrial Extension.

Two-dimensional echocardiography is useful in the diagnosis of cardiac masses, including tumors. Cardiac metastasis of nephroblastoma heralds a worse prognosis. This 4-year-old child presented with clinical and radiological features suggestive of nephroblastoma. She had intracaval spread of the tumor to the right atrium. The cardiac metastasis was initially missed as echocardiography was not part of the routine workup for the patient as she had no clinical features suggestive of cardiac disease. Although cardiac metastasis of nephroblastoma is rare, we recommend routine transthoracic echocardiography for all patients irrespective of the presence of cardiac symptoms and signs.

Repair-oriented categorization of circumcision urethral injury in Benin city, Nigeria.

BACKGROUND: The wide spectrum of circumcision urethral injury/fistula makes selection of appropriate repair methods challenging in sub-Saharan Africa. This paper reports on the outcome of repair-oriented categorization in a Nigerian center. METHODS: Consecutive children presenting with circumcision urethral injury/fistula at the University of Benin Teaching Hospital were categorized into six repair-oriented groups in 2009-2011. RESULTS: 21 children were treated. Except in 2 cases, early neonatal circumcision at an average age of 8 days (range 4-14 days) had been performed, the majority (52%) by paramedics at home. Categories of injury/fistula based on severity ranged from isolated fistula (38%) which required fistula excision and repair (category A) to severe ventral urethral/coronal/glanular avulsion (29%) which required urethral plate tubularization/ventral penile reconstruction (category F). Overall, successful first-stage repair was achieved in 19 (91%) children. Meatal stenosis (2), urethral stricture (1), which responded to serial dilatation, and minor urinary leakage (2), which was closed at second stage, were the post-repair complications. Adequate penile size and straight penis on erection were achieved in all cases. Cosmetic outcome was excellent in 16 (76%) cases, good in 4 (19%) and fair in 1 (5%). CONCLUSION: Repair-oriented categorization, which could be useful to practitioners in similar settings, was satisfactory in managing urethral injury/urethrocutaneous fistula.