Necroturia with acute urinary retention: a rare presentation of bilateral Wilms’ tumour

Background: Wilms’ tumour is one of the most common solid abdominal tumours in children in sub-Saharan Africa. Most cases present with an asymptomatic abdominal mass. We report a 2 year old male child who presented with acute urinary retention of 6 hours duration. He had a left flank mass and ascites, with a piece of necrotic tissue protruding from the urethral meatus. The urinary retention was relieved by manual removal of the necrotic tissue and passage of a Foley’s urethral catheter. Abdominal ultrasound and computed tomographic scan revealed bilateral Wilms’ tumour.The child commenced neoadjuvant chemotherapy and he has made significant improvement.Conclusion: This is a rare mode of presentation of bilateral Wilms’ tumour which presented with a diagnostic dilemma. The need to palpate the abdomen of children who come to the hospital, cannot be over-emphasized.Keywords: Bilateral Wilms’, Tumour; Necroturia, Acute urinary retentio

Wilms' Tumour: Experience in a Developing Tertiary Centre in Nigeria

Background: Children with Wilms' tumour present early in the developed countries with correspondingly good prognosis. The same however is not true in the developing countries where the patient present rather late. This study evaluates the impact of late presentation on the management of childhood Wilms' tumour in our environment. Methods: This was a retrospective study of children aged 0-15 years managed for Wilms' tumour from January 2004 to April 2010 in a Teaching Hospital in South Western Nigeria. Results: Thirty five patients that had nephroureterectomy for Wilms' tumour with a histological confirmation were included in this study. One child had a Stage 1 disease, 9 had Stage II disease, 20 had Stage III disease, 4 had Stage IV disease and 1 child had a bilateral lesion (Stage V). Five (14.28%) patients have completed their chemotherapy and survived without clinical and radiological evidence of recurrence for a period equal to their age at diagnosis plus 9 months (Cullen's law). Therefore they have been deemed cured. Ten patients were lost to follow-up. Others are on various phases of their chemotherapy, 2 patients had Adriamycin cardiomyopathy. There were 6 (17.14%) deaths. Conclusion: Childhood Wilms' tumour presents late in our setting with its consequent management challenges. The need to educate the populace and the primary healthcare providers on the benefits of early diagnosis and treatment of this condition cannot be overemphasized