Search

Purpose: Use of the Mitrofanoff principle is a valuable adjunct to many reconstructive urological procedures in the pediatric age group requiring clean intermittent catheterization (CIC) especially if the urethra is not easily catheterizable. We present our experience with 122 children and analyze the results of this operation. Materials and Methods: 133 Mitrofanoff channels (100 appendicular, 31 ureteric and 2 Monti) were constructed in 122 children (93 boys and 29 girls) of mean age 6.3 years over the period from 1997 to 2005. The procedure was part of the reconstructive procedure in patients of neurogenic bladder (n=44), exstrophy-epispadias (n=40), posterior Urethral valve (n=30), and other diseases (n=8). Additional procedures included augmentation cystoplasty (n=90) and bladder neck procedure (n=46). Results: Mean follow-up was 2.6 years in 109 patients. Overall results were satisfactory. Major complication rates with the Mitrofanoff conduit using appendicular and ureteric channels were 7.4 % in and 25.8%, respectively, most of the ureteric channels due to non-use, there being alternate channels for catheterization. Only six (4.5%) children required re-operation for significant problems with the Mitrofanoff conduit: revision of stoma due to stenosis or kinking (n=4) and closure of stoma due to troublesome leak (n=2). Children and parents were satisfied with the results of the operation and the majority was compliant with regular CIC. All children were socially well accepted and those above 6 years of age were attending regular school. Conclusions: The Mitrofanoff procedure is a feasible and acceptable option, with a low complication rate, for use as part of complex urinary reconstruction in a developing country. Patient education, family motivation, and cost reduction are important factors for success.

A case of incidentally detected Metanephric Stromal Tumour (MST) is reported here. This is a rare, recently recognized pediatric benign stromal specific renal neoplasm. A review of the English literature revealed only five cases after its original description by Argani et al. Recognition of this entity can spare a child from potentially toxic adjuvant chemotherapy that might be used to treat malignant lesions which are part of the differential diagnosis, particularly clear cell sarcoma of kidney (CCSK).

Aim: To illustrate the etio-pathology and appropriate management in a group of six children with persistent recto-urethral fistula after anorectal malformation surgery. Materials & Methods: Six children presented with passing urine from surgically constructed neoanus. Suspected causes included missed recto-urethral fistula with inadequate pullthrough, retraction of neoanus with recurrent recto-urethral fistula, rectal damage, urethral damage and in one case inadvertent excision of upper urethra and part of bladder. Treatment & Results: The above children were treated with variety of methods including PSARP, Abdomino-sacroperineal pullthrough, Rectus muscle flap interposition, Endorectal pullthrough and in one case urinary diversion as an ileo-cecal bladder. Conclusion: Persistent recto-urethral fistula after ano-rectal malformation surgery has varied etiology and appropriate management has to be individualized. [ABSTRACT FROM AUTHOR]

Aim: The cases of Posterior urethral valves (PUV) with vesicoureteric reflux (VUR) remains at risk of recurrent urinary tract infections and continued renal deterioration even after adequate valve fulguration. In recent times a high pressure valve bladder has been recognized as the culprit. We propose unilateral refluxing loop or Y- ureterostomy as an additional treatment method to provide a pop-off mechanism for the entire urinary system and we present our result in 25 cases treated by this method. Materials and Methods: We retrospectively reviewed the records of 25 cases of PUV with unilateral or bilateral VUR aged 1 day to 18 months; all underwent PUV fulguration along with unilateral ureterostomy on the side with vesicoureteric reflux and in cases with bilateral VUR, ureterostomy on the major refluxing side. Serum creatinine, frequency of urinary tract infections (UTIs), status of HUN and vesicoureteral reflux (VUR) were evaluated during the follow up. Results: All patients underwent primary endoscopic valve ablation along with unilateral ureterostomy on the refluxing side. Apart from 3 patients whose serum creatinine continued to rise despite the procedure, the remaining patients have done well with marked improvement in serum creatinine, resolution of hydroureteronephrosis and reduction in febrile UTIs. Ureteric reconstructions has been done in 4 cases in the form of transureteroureteric (TUU) anastomosis leaving the lower ureteric stump as Pop-off, ureterostmy closure done in 5 cases with remaining cases still on ureterostomy waiting for reconstruction. 3 cases required other side ureterostomy also for recurrent UTIs and elevated serum creatinine level during follow up. Conclusion: In patients with PUV, primary endoscopic valve ablation and temporary urinary diversion with refluxing ureterostomy have a positive influence on renal and bladder function. It immediately releases high intrarenal pressures even on the contra lateral side and not only improves renal function but also leads to reduction in the febrile UTIs. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to analyze the outcome of Hepaticoduodenostomy (HD) in patient with Choledochal Cyst. Materials and Methods: 72 patients with Choledochal cyst were operated over past 7 years. Among them 43 underwent HD after cyst excision. Most common complaint in these patients at presentation was abdominal pain with one or more episodes of jaundice. One patient was antenatally detected to have Choledochal cyst. 26 among these 43 patients were girls; average age of presentation was 6.8 years (Range 1year - 15 years). Average duration of admission was for 7 days with nasogastric drainage for 4 days and nil per oral for 5 days. All HD was done below the hilum to first part of duodenum. Duodenum was kocherised to form a tension free anastomosis. Suture line was further reinforced with an omental wrap. Results: No major complications namely cholangitis, calculi encountered in any of our patient during follow up. Duration of follow up ranged from 6 months - 24 months (mean 15 months). Follow up was done in OPD with Liver Function Test, Ultrasound and HIDA scan. Conclusion: Hepaticoduodenostomy is the most natural/physiological technique of reconstruction after cyst excision because it offers many advantages over other techniques, by limiting the operative field to the supra colic compartment and a single anastomosis. Apart from this it allows access to the biliary tree via an endoscope in the event of calculi/anastomotic stricture. Despite the controversy regarding this procedure in literature, we find HD a safe option in the treatment of Choledochal cyst [ABSTRACT FROM AUTHOR]