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With the increasing popularity of laparoscopic urologic surgery, many different methods have been used to dissect the extraperitoneal space and gain access to the kidney and ureter. We present our initial experience using a Foley catheter to gain retroperitoneal access. This technique was successfully used in 30 children. We have not encountered any major complications and recommend its use in children.

Priapism is a rare condition in childhood. The majority of reported cases are boys with sickle cell disease, in whom nonoperative management may be successful when patients present early. We report a 14-year-old boy with sickle cell disease who presented with priapism of 72-h duration and was successfully treated by bilateral saphenocorporal shunts.

Rhabdomyosarcoma is one of the commonest soft tissue sarcomas of childhood, but neonatal presentation is extremely rare. This limited experience means there are no clear treatment guidelines in this age group. The authors report a boy with recurrent attacks of hematuria commencing in the neonatal period, which were shown to be from a prostatic rhabdomyosarcoma. To the best of our knowledge this is the first reported case of neonatal rhabdomyosarcoma in this site., (Copyright 2004 Wiley-Liss, Inc.)

Vancomycin susceptibility was checked in isolates from initial and final blood samples obtained from 22 patients with persistent or recurrent methicillin-resistant Staphylococcus aureus bacteremia. The minimum inhibitory concentration of vancomycin was determined using Etest and found to have increased in 2 pairs of isolates, and results of screening in 4 mu g vancomycin and a modified population analysis profile suggested heteroresistance in 3 isolates (13.6%). Heteroresistance is not a common cause of persistent or recurrent bacteremia.

Penile agenesis is a rare anomaly, occurring once in every 30 million births. Early gender reassignment and genital reconstruction helps the family to accept the child's altered gender and to reduce psychological problems. In the past, multiple operations were carried out to form feminized external genitalia. This report describes a single-stage gender reassignment and genital reconstruction by anterior sagittal anorectovaginourethroplasty in a neonate with penile agenesis.

The authors report 3 cases of Hirschsprung's disease that were treated by laparoscopic-assisted transanal pull-through after a colostomy already had been performed. Two of these patients presented with severe enterocolitis, and a primary laparoscopic-assisted single-stage transanal pull through was not feasible. The third patient had a colostomy performed and was referred to us for a definitive procedure. Many centers over the world now perform laparoscopic-assisted single-stage pull-through as a primary modality of management for Hirschsprung's disease. But for a country like India, where patients with Hirschsprung's disease present or are referred late and frequently with enterocolitis, performing a primary procedure is not possible in all cases. However, this has been used as the definitive procedure after performing a diverting colostomy and histopathologic determination of the length of the aganglionic bowel. The procedure gives excellent results and permits early postoperative feeding, early hospital discharge, and good cosmetic results.

We report a 9-month-old child with anorectal anomaly which was surgically treated in the neonatal period for a colostomy and was referred to us for a definitive procedure. The child had features suggestive of low anorectal abnormality; however, investigations indicated that he had a supralevator type of imperforate anus associated with a rectopenile subcutaneous fistula. The surgical treatment of this infant is discussed.

Among the various anomalies associated with Down syndrome, leukemia is quite common. The variant transient myeloid leukemia is seen almost exclusively in the Down syndrome patients. On the other hand, urological anomalies are infrequently found both in the Down syndrome and leukemia patients. We report a case who had the rare combination of a urological anomaly along with Down syndrome and transient myeloid leukemia.

When managing neonatal jaundice, there is no single test or imaging modality that can reliably define biliary atresia and neonatal hepatitis. Early diagnosis is an important step for surgical success in extra hepatic biliary atresia. In many situations, exploratory laparotomy and operative cholangiography may be needed to settle the definitive diagnosis, with the risk of having negative exploration in those high risk patients with medical etiology. The use of laparoscopy may help in avoiding unnecessary exploration for such group of patients and arriving at a definite diagnosis. Six patients with conjugated hyperbilirubinemia were evaluated with a diagnostic laparoscopy, laparoscopic cholangiography and liver biopsy. Three of the six patients were diagnosed to have neonatal hepatitis and so an unnecessary laparotomy was avoided in these cases.

The usual treatment for empyema in children varies from a simple thoracocentesis to thoracotomy and open decortication. We studied the role of thoracoscopy in the management of empyema thoracis in 10 immunocompetent children after failure of medical management. All children recovered well with an early removal of intercostal tube and reduced postoperative hospital stay and showed complete resolution of empyema on follow up. Thoracoscopy has come as a new ray of hope for the patients with empyema, with the advantages of complete evacuation, minimal pulmonary dysfunction, reduced pain and hospital stay.