Voiding cystourethrogram in the diagnosis of vesicoureteric reflux in children with antenatally diagnosed hydronephrosis

Prenatal ultrasonography has revolutionized the detection and management of many urological abnormalities. Vesicoureteric reflux (VUR) which develops in 10% to 15% of cases of prenatal hydronephrosis, is difficult to predict prenatally. While all children with prenatal hydronephrosis should undergo ultrasonography within the first few weeks of life, there seems to be controversy regarding the role of voiding cystourethrogram (VCUG) in the assessment of these children

Vascularized tunica vaginalis interposition flap for the treatment of recto-urethral fistulas

Introduction : Recto-urethral fistula is a rare complication of pelvic surgery, trauma, or inflammation. The many techniques for repairing these fistulas vary in their success rates. We describe the use of vascularised tunica vaginalis flap interposition in the repair of a recto-urethral fistula. Materials and Methods : Three children who had developed rectourethral fistula following surgery for anorectal anomaly/Hirschsprungs disease underwent repair through the perineal approach and interposition of vascularised tunica vaginalis flap in between the rectum and the urethra. Results : Three patients, all males aged 6 to 14 years old, presented with passage of urine per rectum following surgery. Following repair of the recto-urethral fistula, there was no recurrence of fistula in the follow-up period ranging from 1 to 6 years. Conclusions : Vascularised tunica vaginalis flap interposition is a straight-forward technique that can result in successful fistula repair

Cellulitis and deep venous thrombosis: A rare association

A nine-year-old male child presented to us with a history and clinical examination suggestive of bilateral lower limb cellulitis. Investigations revealed leucocytosis, decreased Protein S levels, and growth of methicillin-resistant Staphylococcus aureas in the blood and pus cultures. A Doppler study revealed bilateral lower limb deep vein thrombosis (DVT). The child underwent fasciotomies under the cover of antibiotics and the DVT was treated with heparin followed by oral anticoagulation. In cases of cellulitis, DVT should be ruled out, as the clinical features of cellulitis may mask those of DVT, leading to missed diagnosis and serious complications

Bladder exstrophy in adulthood

Background: We report our experience with the treatment of classic exstrophy of the bladder in a small series of seven adult males. There are very few documented cases of adults presenting with exstrophy of bladder in literature. Materials and Methods: Adult males presenting with classic exstrophy of the bladder and complete epispadias underwent detailed evaluation including psychological assessment and counseling. All were explained regarding the surgical procedure and informed about the need for self-catheterization. Prior to 2002 all patients underwent cystectomy of the existing bladder plate, with creation of catheterizable modified Mainz pouch. Since 2002 patients were assessed for bladder reconstruction with augmentation ileocystoplasty, bladder neck reconstruction, and abdominal wall closure. Results: Seven adult males with classic exstrophy of the bladder and complete epispadias who had not received any previous treatment presented to us during the period 1991-2006. Five of these underwent cystectomy with continent pouch and the remaining two underwent bladder reconstruction. All have been doing well with improved self-esteem and social interaction. Two of these have married and leading a satisfactory sexual relationship. Conclusions: Surgical correction in adults with exstrophy of the bladder greatly improves self-esteem, confidence, and social relationship