Childhood and adolescent idiopathic urethritis: what does the current literature say?

Introduction: Idiopathic urethritis (IU) is a known entity in the childhood and adolescent age groups and is described as blood spotting of the underwear in these populations. Typically, IU presents clinically as terminal void haematuria or blood spotting, accompanied with dysuria, occasional suprapubic pain and rarely constitutional symptoms. Sometimes IU may progress to formation of urethral strictures.

Prospective study on the incidence of bladder/cloacal exstrophy and epispadias in Europe.

Objective: On behalf of the European Society of Paediatric Urology (ESPU), a prospective study was designed with the aim of defining the actual number of babies born with bladder exstrophy, cloacal exstrophy, and epispadias in Europe over a 12-month period, and verifying the distribution of the exstrophy patients born during the study period among the different paediatric urology centres in Europe.

Study Design: The study was structured with a chief investigator and one national investigator for each country enrolled in the study. The national investigators nominated one local investigator for each European centre of paediatric surgery/paediatric urology and urology where the exstrophy complex could potentially be treated.

Psychosocial screening at paediatric BEEC clinics: a pilot evaluation study.

Introduction: Bladder Exstrophy and Epispadias Complex (BEEC) is associated with an increased risk of impaired mental health, quality of life, and psychosocial functioning. Therefore, screening patients to help identify and evaluate potential psychosocial difficulty is arguably an important consideration for BEEC Services.

Objective: To screen paediatric BEEC patients for a range of general psychosocial difficulties in a multi-disciplinary out-patient clinic setting.

New alternative Mitrofanoff channel based on spiral intestinal lengthening and tailoring.

Introduction: The occasional lack of appendix and the increasing use of the Malone anterograde continence enema (MACE) procedure have expanded the need for alternative Mitrofanoff channels. The Monti procedure does not always provide adequate length, the anastomosis of the double Monti, and the potential kink of the Casale channel is not ideal for smooth catheterisation. We tested the concept of spiral intestinal lengthening and tailoring (SILT), we developed originally for short bowel syndrome, to create a long and straight alternative Mitrofanoff channel (Figure).

Novel approach to vaginal calculus in a girl with urogenital sinus anomaly.

Isolated urogenital sinus can cause distended bladder and/or vagina and may present with an abdominal mass and sepsis during infancy. Older children may present with recurrent urinary tract infections and hematocolpos. We describe a 3-year-old girl with recurrent urinary tract infections thought to be secondary to vesicoureteric reflux.

The management of bladder exstrophy: the Manchester experience.

Aim: Bladder exstrophy (BE) is a severe congenital malformation with life-long implications. This article discusses the current surgical management and describes the development of the nationally commissioned bladder exstrophy service in Manchester, UK.

Methods: Outcome of BE surgery in Manchester was retrospectively reviewed.

Delayed exstrophy repair (DER) does not compromise initial bladder development.

Objective: Delayed exstrophy repair (DER) represents an alternative to early neonatal bladder closure. This study aims to define the consequence of DER on bladder growth in bladder exstrophy patients who underwent routine DER, compared with those who underwent immediate postnatal reconstruction.

Methods: Between 2000 and 2005, classic bladder exstrophy patients referred to the authors' institution underwent early neonatal bladder closure (group 1).

Shortened pubic bones in bladder exstrophy: a congenital or acquired phenomenon?

Objective: It is accepted that the length of the anterior segment of the pelvis in classic bladder exstrophy is shorter than that of controls. However, studies performed involve children with a wide range of ages. By studying children with classic bladder exstrophy under the age of 1 year, the authors aim to ascertain if there is a congenital pubic bone length discrepancy associated with bladder exstrophy.

Multiple urethral anomalies: anterior urethral diverticulum, posterior urethral valves, and distal hypospadias.

We report an infant with antenatally detected bilateral hydroureteronephrosis and a penile cyst who was eventually diagnosed with an anterior urethral diverticulum (AUD), subcoronal hypospadias, and posterior urethral valves (PUV) after birth. To our knowledge, there are no reports where all three anomalies have been found to coexist. As per urethral catheterisation was difficult, cystoscopy-guided catheterisation was performed.

Relationship between the size of the bladder template and the subsequent bladder capacity in bladder exstrophy.

Aim: The aim of this study is to evaluate the relationship between the size of the bladder template in infants born with bladder exstrophy and the subsequent bladder capacity at the age of 1 and 5 years.

Materials And Methods: Infants with bladder exstrophy were photographed at birth, and 2 parallel lines were drawn transversally on the photograph across the anterior-superior iliac spines and on the bladder template. The ratio between the 2 lines was calculated, and the bladder templates categorized as (a) small (≥ 4), (b) medium (3-4), and (c) large (<3).

Outcome study of upper pole heminephroureterectomy in children.

Objective: We assessed the role and long-term outcome of upper pole heminephroureterectomy in the treatments of non-functioning upper renal moieties in children with duplex kidneys.

Methods: In a period of 10 years, forty-three patients (male: female ratio 6:37) underwent upper pole heminephroureterectomy; a total of 25 patients were diagnosed prenatally. Imaging modalities included renal and bladder ultrasound in all 43 patients, static 99 m technetium dimercaptosuccinic acid (DMSA) in 21 patients, micturating cystourethrogram in 28 patients, MAG-3 in 13, cystoscopy in 30, IVU in 31 and DTPA, retrograde pyelography, antegrade pyelography in 1 patient.

Oral mucosa graft for repair of hypospadias: outcomes at puberty.

Purpose: Oral mucosa graft has been used in the treatment of hypospadias for the last 15 years. We assessed the long-term outcome of oral mucosa grafts for urethral substitution in hypospadias surgery at our institution.

Materials And Methods: We retrospectively reviewed patients who underwent oral mucosa graft for hypospadias between 1994 and 2002.

Surgical intervention in children with vesicoureteric reflux: are we intervening too late?

Background: Vesicoureteric reflux is usually managed medically. When medical management fails, the patient is referred for surgical intervention. The aim is to protect the kidneys from progressive damage.

Outcome study of lower pole heminephrectomy in children.

Objective: This study assessed the role and long-term outcome of lower pole heminephrectomy in the treatments of non-functioning lower renal moieties in children with duplex kidneys.

Material And Methods: In a period of 10 years 31 lower pole heminephrectomies were performed in 30 patients with duplex systems. Eight patients were diagnosed prenatally, 24 patients (80%) presented with urinary tract infection and three (10%) with vomiting and failure to thrive, and five patients also had other symptoms.

Congenital diverticulum of the bladder mimicking tumour.

The incidence of bladder diverticula is low and identification is usually straightforward with contrast studies. We present a case of a child who had a clearly identified bladder diverticulum as well as a soft-tissue lesion in the posterior wall of the bladder that was suspected to be a rhabdomyosarcoma. Despite ultrasound scanning, micturating cystourethrogram, computed tomography and cystoscopy, open surgery was required to rule out tumour.

Construction of a natural looking inverted umbilicus for bladder exstrophy.

Purpose: Most attempts to create an umbilicus in the exstrophy abdomen eventually leave the end result of a flat scar rather than an inverted structure. We describe a technique that allows the creation of a better looking inverted umbilicus.

Materials And Methods: A total of 19 patients between 5 days and 7 years old underwent umbilicoplasty.

An unusual bladder/cloacal exstrophy with urachal exstrophy.

The authors report a previously unpublished association of bladder exstrophy with cleft lip, exomphalos, Meckel's diverticulum imperforate anus, and a large urachal mass protruding below the umbilicus. The baby underwent surgical repair of the condition and the postoperative recovery was uneventful. None of the theories formulated to explain the embryogenesis of bladder exstrophy can explain these findings.

Rectus sheath tunnels for continent stomas.

Continent stoma rectus sheath tunnel (CSRST) has been used in antegrade colonic enema (ACE) and urinary continent cutaneous diversion (UCCD) stomas to reduce leakage and to support a straight track for the continent conduit. All patients that underwent CSRST between 1995 and 2005 were identified and their case notes retrospectively reviewed. Patients were divided into two groups: the ACE group and the UCCD group.

Salvage procedures to achieve continence after failed bladder exstrophy repair.

Purpose: We assessed the results from a single exstrophy center of salvage continence surgery after failed staged reconstruction for bladder exstrophy.

Materials And Methods: A total of 32 patients with bladder exstrophy had undergone salvage continence procedures. Indications for surgery included incontinence due to poor bladder capacity or failed bladder neck repair, and upper tract deterioration.

An objective assessment of the results of hypospadias surgery.

Objective: To compare the cosmetic result of tubularized incised-plate urethroplasty (Snodgrass method) with that of two established techniques, the meatal-based flap and onlay island flap repair.

Subjects And Methods: Photographs of the penis after hypospadias repair in 32 boys were assessed by a panel of five independent health professionals, including four surgeons with variable paediatric urological experience and a urology nurse. Twenty patients had a distal and 12 a proximal meatus.