Urodynamically proven lower urinary tract dysfunction in children after COVID-19: A case series

Case Since the declaration of COVID-19 as a pandemic, other unexpected symptoms related to the infection besides the respiratory system have been reported. Although a few case reports have revealed that adult patients with COVID-19 also complained of urinary frequency and nocturia, the exact pathophysiology is still unclear. In this case series, we present three children aged 14 to 17 years with urodynamically proven lower urinary tract dysfunction (LUTD) following COVID-19. Outcome None of the patients had constipation or bowel disorder before the diagnosis of COVID-19. In addition, neurological examination and related imaging revealed no signs of etiological factors. The median time from diagnosis of COVID-19 infection to the onset of lower urinary tract symptoms was 3 months. Incomplete bladder emptying/urinary retention supported by increased bladder compliance, high post-micturition residual urine volumes, and absence of detrusor pressure increase during the voiding phase in the pressure flow study (acontractile detrusor in two patients and hypocontractile detrusor in one patient) were observed. Conclusion We observed that LUTD (eg, incomplete bladder emptying, urinary retention) can be prominent some time after the diagnosis of COVID-19. Even though psychogenic or neurogenic causes may not be excluded completely, clinicians should be aware of a recent COVID-19 infection in children with sudden-onset LUTD

Neuroblastoma diagnosed after surgery for a benign condition

We report a case of neuroblastoma diagnosed in an infant 8 months old who was being followed-up due to antenatal hydronephrosis. Postnatal imaging findings were suggestive of bilateral UPJ obstruction. Left pyeloplasty was performed on the postnatal third month. An emergent early postoperative CT scan, performed due to considerable decrease in Hb/Htc values, revealed negative results for any kind of collection or tumor. At the postoperative fourth month, USG revealed a solid left adrenal mass. Blood and urine test results were suggestive of neuroblastoma. On surgical exploration adrenal mass was excised. Pathologic examination confirmed the diagnosis of neuroblastoma. Patient had stage 1 disease with favourable histopathologic features. This low-risk tumor, can be treated with primary surgery alone with excellent outcomes. Neuroblastoma either detected by mass screening programs or diagnosed incidentally on urinary tract imaging expected to be localized and have a good prognosis

The management of renal candidiasis in a newborn infant with posterior urethral valve

Renal candidiasis with fungal bezoars in the newborn infant is rarely encountered. We report a newborn with renal candidiasis and posterior uretral valve treated by local irrigation of the kidneys (three weeks) with amphotericin B via percutaneously inserted nephrostomy catheter, in combination with intravenous flucanazol (four weeks). Renal function subsequently improved and fungal bezoars disappeared sonographically. No side effects were observed during the follow up. We suggest that local irrigation with amphotericin B in combination with systemic flucanazol may be the initial treatment of renal candidiasis, aiming at both the restoration of renal function and the eradication of the fungal infection

Outcomes of a newly established transitional urology outpatient clinic: a real-world experience.

PurposeTo evaluate the demographic and clinical characteristics of patients who visited our transitional urology (TU) outpatient clinic formed by pediatric urologists with urology background within the first year upon its establishment.MethodsFiles of 130 consecutive patients who visited our TU outpatient clinic, which was established in 01 March 2021, between 01 March 2021 and 01 March 2022 were retrospectively collected. Patients were divided into two groups: those with a previous follow-up in our pediatric urology department (Group I, n: 81, 62.3%) and those who were followed up in other clinics during childhood (Group II, n: 49, 37.7%) afterwards. Demographic characteristics, complaints at admission, previous medical history, and management plans at the recent clinical visit were noted. We defined a successful and smooth transition from childhood to adult care as not being without follow-up within the first year after the age of 18 years and not requiring extraordinary medical assistance (e.g., emergency room visits, hospitalization, intensive care unit admissions) from the last urological control to the TU outpatient clinic visits.ResultsThe most common diagnoses were vesicoureteral reflux (n: 32, 24.6%), neuropathic bladder accompanied by spina bifida (n: 31, 23.8%), obstructive uropathy (n: 25, 19.2%), hypospadias (n: 20, 15.3%), non-neurogenic lower urinary tract dysfunction (n: 19, 14.6%), and bladder exstrophy (n: 8, 6.1%). The distribution of primary diagnosis in the two patient groups was similar. The median time from the last pediatric urology visit to the current TU clinical visit was significantly longer in Group II (12 vs. 60 months, p < 0.001),consequently, the median patient age at admission was significantly higher in Group II (21 vs. 23 years, p = 0.020). The rate of a successful and smooth transition was 86.4% in Group I, whereas Group II had a completely unsuccessful transition period. Upon admission to TU outpatient clinic, the requirement of a surgical intervention was lower in Group I (21% vs. 38.8%, p = 0.028).Also,the need for medical treatment changes was higher in Group II (9.9% vs. 53.1%, p < 0.001).ConclusionOur findings emphasize the importance of patient referral to a TU clinic that deal with lifelong problems of congenital genitourinary diseases. Delays in receiving medical or surgical treatments during transition from childhood to adulthood may be associated with higher need for subsequent surgical interventions in this vulnerable patient population

Retroperitoneoscopic Ablative Renal Surgery in Children: The Feasibility of Using Three Trocars

Purpose: We report the results of pediatric retroperitoneoscopic renal ablative surgeries, which were performed with only three trocars