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Capillary hemangioma is a rare benign lesion in the testicle, particularly in pediatrics. It can mimic malignancy, leading to radical orchiectomy. We present a case of a testicular hemangioma in a child, and review the literature on testicular hemangiomas in this age group. A hypervascular testicular lesion without elevated tumor markers may warrant intraoperative biopsy to direct surgical management, which may include testis-sparing surgery if amenable. [ABSTRACT FROM AUTHOR]

Objective: To characterize contemporary resource utilization and medical outcomes for infants with antenatal hydronephrosis and their mothers from a national claims database. We hypothesize that management of isolated hydronephrosis (IHN) varies widely, with decreased imaging following the 2010 Society for Fetal Urology Consensus Statement.Materials and Methods: Using MarketScan claims from 2007 to 2013, we identified infants 0-12 months of age with hydronephrosis and linked mothers. Those with urologic diagnoses more specific than hydronephrosis, additional urologic comorbidities, or postnatal surgeries were excluded. Resource utilization including prenatal and postnatal imaging, laboratory studies, hospital admissions, and medical outcomes within the first year was captured. Demographics, maternal characteristics, utilization measures, and outcomes were compared across imaging intensity groups based on number of postnatal ultrasounds received using bivariate analysis.Results: Among 801,919 mother-child pairs, 8610 infants (1.1%) had hydronephrosis or a related diagnosis. A total of 5876 (68.2%) met inclusion criteria for IHN. Patients underwent a mean 5.3 ± 3.5 prenatal and 2.1 ± 1.3 postnatal ultrasounds before age 1. Imaging practices were unchanged following the Society for Fetal Urology consensus statement.Conclusion: Antenatal hydronephrosis prevalence in an insured population is consistent with published ranges. Prenatal imaging in IHN is variable and potentially excessive. Future study into the efficacy of evidence-based pathways in reducing excess utilization is warranted. [ABSTRACT FROM AUTHOR]

Abstract: Hypospadias repair is one of the more common operations in pediatric urology centers, with an incidence of 1 in 200 to 1 in 300. This review provides an overview of the prevalence, epidemiology, etiology, and treatment of this condition. Indications for hypospadias repair and preoperative hormonal treatment are discussed. The principles of the different operations and their countless modifications are explained. Hypospadias repair has a long and flat learning curve and requires patience, experience, and great enthusiasm to achieve acceptable results. The results published on the various operative techniques need to be repeated and validated by other surgeons, and long-term results (up to adulthood) are essential to justify operative methods and identify late complications. [Copyright &y& Elsevier]

Objectives: To present the diagnostic results of contrast vaginography to detect a vaginal ectopic ureter, in addition to investigation with ultrasonography, intravenous urography, and technetium-99m-dimercaptosuccinic acid renal scan. A single ectopic ureter is a rare anomaly. Methods: Eighteen girls with a single ectopic ureter were treated at the Children''s Hospital No. 1 from 1995 to August 2008. The diagnostic studies included ultrasonography, intravenous urography, renal scans, and, finally, vaginography with contrast if the renal scans could not detect the poorly functioning kidneys. Results: Intravenous urography showed a poorly functioning kidney in 1 patient. Another 10 poorly functioning kidneys were revealed by technetium-99m-dimercaptosuccinic acid renal scan, but 7 kidneys were not identifiable using contrast, ultrasonography, or radionuclide. Of these 7 patients, 6 vaginal ectopic ureters were detected using contrast vaginography. All 18 dysplastic kidneys were surgically removed. Conclusions: The results of the study have demonstrated the satisfactory diagnostic value of vaginography as an imaging technique to detect the dysplastic kidney draining by a single ectopic ureter. [Copyright &y& Elsevier]

The article discusses the use of standardized imaging techniques to visualize the kidney and urogenital tract (UGT) of infants and identify neonatal UGT conditions. It cites the imaging techniques in pediatric urology, including ultrasonography (US), intravenous urography (IVU) and computed tomography (CT). It notes the importance of identifying the reasons of the investigation, the possible results and right timing. It also mentions the specific imaging algorithms for neonatal UGT conditions.

As enterocystoplasty has become a routine procedure in pediatric urology, long-term complications are emerging in adult patients. Pediatric urologists in general do not follow their patients beyond late adolescence. The sequelae of enterocystoplasty have fallen into the hands of their adult colleagues. Some of the complications of enterocystoplasty, such as reservoir stones, malignancy and perforation, are also seen in older adults following continent diversion. On the other hand, problems with bone growth, pregnancy and reflux nephropathy are unique to children and young adults. A better awareness and understanding of these complications will lead to improved prevention, surveillance and treatment. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the outcome of primary vesicoureteral reflux (VUR) using conservative treatment. Methods: Eighty-seven children with primary VUR who had been treated with a conservative medical regimen and monitored through a yearly cystogram were recruited for the study. The study was conducted at the Pediatric Nephrology Clinic in Songklanagarind Hospital, the major tertiary care center in southern Thailand. Statistical analyses using Kaplan–Meier survival curves, chi-squared test, Fisher’s exact test and multivariate analysis with Cox regression were performed. Results: The study group consisted of 41 boys and 46 girls, with a total of 133 VUR. The age of the boys was significantly lower than that of the girls ( P < 0.001). Resolution of the low grades (grades I–III) of VUR was significantly more frequent than that of the high grades (grades IV–V) (68/95, 72% vs 14/38, 37%; P < 0.001). Using the Kaplan–Meier survival analysis and log-rank test, the resolutions of VUR in boys versus girls, and age <1 years versus ≥1 years were not significantly different ( P = 0.2252 and 0.4756, respectively). Low-grade VUR and unilateral VUR had significantly higher probabilities of resolution than high-grade VUR and bilateral VUR, respectively ( P = 0.0041 and 0.0467, respectively). Multivariate Cox regression analysis indicated that among low-grade VUR, boys and unilateral VUR had significantly higher probabilities of resolution. Among the high-grade VUR, neither sex nor laterality had a significant effect on the probabilities of VUR resolution. Conclusion: This study offers more evidence that children with low-grade VUR have a higher chance of reflux resolution if they are boys and have only unilateral VUR. There is still no good guide for resolution of reflux in children with high-grade VUR. [ABSTRACT FROM AUTHOR]

The article focuses on the aid of radiological imaging to differentiate upper and lower urinary tract infection (UTI) among children. It states that paediatric uroradiology is one of the backbones of radiological practice for UTI. It discusses various imaging systems used for UTI such as dimercaptosuccinic acid (DMSA) scintigraphy, ultrasound (US), and voiding cystourethrography (VCUG). It concludes that radiological imaging in UTI remains crucial for children such as radiation exposure.

To study the surgical treatment and outcome of hydronephrosis secondary to pelviureteric junction obstruction (PUJS) that is so massive that the renal pelvis crosses over the vertebral column [mega-hydronephrosis (MH)]. Of the 40 cases of PUJS we treated over the past 5 years, 6 cases had MH secondary to PUJS (MH-PUJS) in 6 renal units and were reviewed. Incidence of MH was 15.0%. All had Anderson-Hynes dismembered pyeloplasty to treat obstructive renal pattern on technetium-99m diethylenetriaminepentaacetic acid (DTPA) scans in five and gait disturbance due to MH in one. The contralateral kidney was normal in five and dysplastic in one. Three had nephrostomy before pyeloplasty. Preoperative DTPA scans showed good renal function in four and poor in two. Plication of the entire dilated, lax renal parenchyma ("nephroplication") was performed in three to decrease the intra-renal pelvic cavity. Prenatal diagnosis was performed in three cases. Mean age at pyeloplasty was 3.5 years and mean duration of follow-up was 1.5 years. Postoperatively, two of the three who did not have nephroplication had prolonged but not obstructed renal pattern on DTPA scans, and the other case who did not have nephroplication had nephrectomy for non-functioning kidney caused by recurrent pyelonephritis 2 years after pyeloplasty. In the three who had nephroplication, DTPA scans showed acceptable to relatively good passage in all cases. The surgical treatment of MH-PUJS is challenging with no fixed guidelines. However, nephroplication may be useful during pyeloplasty to decrease the size of MH-PUJS. [ABSTRACT FROM AUTHOR]

The article focuses on the need for morbidity grading system for diagnosis of pediatric urology. Topics discussed include surgical complications made by urologists; repeated episodes of anesthesia and increasing radiation exposure with increased risk for developmental delays; and Unplanned Postoperative Morbidity in Children (UPMC) classification system for improving pediatric quality of life.

The article cites a finding which evaluates the relevance of the cremasteric reflex during physical examination in diagnosing the presence of testicular torsion. It notes, however, that some case reports showed a coexistence between the two factors. It also offers several resolutions from the authorities regarding the problem which includes Doppler ultrasound from the European Society for Pediatric Urology (ESPU), and radionuclide scrotal ultrasound (RNSI) from the American College of Radiology.

The article discusses the integration of robotic assisted surgery in several procedures in pediatric urology such as pyeloplasty, nephrectomy and ureteral reimplantation. Topics discussed include how robotic surgery enables pediatric urologists to overcome the limitations of conventional laparoscopy, the increased popularity of robotic assisted laparoscopic surgery in pediatric urology in the last decade and its proven success as open procedures and the better visualization it provides.