Partial urogenital mobilization in cloacal malformation: is it a viable option?

Introduction: Total Urogenital Mobilization (TUM) has been the standard surgical approach for the urogenital complex in Cloacal Malformations (CM) since its inception in 1997. Partial Urogenital Mobilization (PUM) in CM remains an under-utilized or under-reported option. The main anatomical difference between TUM and PUM is the division of the pubo-urethral ligaments.

Radical resection of lumbosacral lipomas in children: the Great Ormond Street Hospital experience.

Purpose: In 2009, Pang described a radical resection technique for congenital lumbosacral lipomas, with lower long-term symptomatic re-tethering rates compared with partial resections and conservative management, and low surgical morbidity. We adopted this technique in 2011, and aim to describe our first results.

Methods: In this monocentric retrospective audit, we included dorsal, transitional, chaotic, and caudal-type lumbosacral lipomas.

Does conus morphology have implications for outcome in lumbosacral lipoma?

Objective: Lumbosacral lipomas (LSL) of the 'dorsal' type have been associated with more favourable outcomes compared with other conus region lipomas. We hypothesised that integrity of the conus on MRI underpins the improved prognosis in this subgroup of LSL patients.

Methods: The definition of 'dorsal lipomas' included lipomas with attachment to the conus, but where the conus could be delineated on MRI (Morota type 1) as reported by Morota et al.

Outcomes of urinary tract abnormalities diagnosed by the routine third trimester scan.

Objective: The aim of this study is to determine the incidence of congenital abnormalities of the kidneys and urinary tract (CAKUT) detected for the first time in an unselected population undergoing a routine third trimester scan between 30-34 week's gestation.

Methods: This was a retrospective analysis of 8562 routine third trimester ultrasound scans during which the fetal anatomy was evaluated, and, any structural abnormalities detected, recorded onto a fetal database which was subsequently analysed for CAKUT. All postnatal records of antenatally diagnosed CAKUT were obtained and analysed for diagnosis and management.

Isolated bilateral simplex ureteric ectopia: Bladder capacity as an indicator of continence outcome.

Introduction: Isolated bilateral simplex ectopic ureters (BSEUs) are rare but pose a therapeutic challenge: ureteric reimplantation alone does not accomplish continence in all. Identifying the patients needing additional procedures for continence early could prevent multiple operations.

Objective: Potential preoperative indicators for postoperative continence are explored in eight BSEU girls without cloacal, anorectal, or spinal anomalies.

What is the risk of urinary tract infection in children with antenatally presenting dilating vesico-ureteric reflux?

Introduction: The incidence of recurrent urinary tract infection (UTI) in children with primary vesico-ureteric reflux (VUR) presenting symptomatically is well documented. The risk of UTI in asymptomatic primary VUR diagnosed on investigation of antenatal hydronephrosis (ANH) is less clear. Paradoxically, several previous studies have suggested a lower risk (1-25%).

Periurethral and vulval condylomata acuminata: an unusual juvenile venereal disease in a 3-year-old girl.

We present a case of giant condyloma acuminatum (CA) in a 3-year-old girl with rapidly growing vulval and periurethral lesions, which was investigated thoroughly and successfully treated with excision biopsy. Genital warts in the form of giant alarming vestibular, vulval and periurethral lesions of CA are very rare in children. There is need for a multidisciplinary approach with potential sociomedicolegal implications.

Testicular outcome following laparoscopic second stage Fowler-Stephens orchidopexy.

Objective: To assess outcome after laparoscopic second-stage Fowler-Stephens orchidopexy (L2(nd)FSO).

Patients And Methods: Retrospective review of 94 children (aged 0.75-16 years, median 2.

Interventions for impaired bladders in paediatric renal transplant recipients with lower urinary tract dysfunction.

Dysfunctional bladders in paediatric patients were thought to be a contraindication for renal transplantation, but advances in surgical techniques have meant that surgical correction can allow safe transplantation. This study compares the outcomes of renal transplantation for different interventions, and the timing of such interventions, in relation to transplantation. We identified all paediatric renal transplant recipients with LUTD that received intervention for their impaired bladders at two hospitals between 2002 and 2010.

Asymptomatic lumbosacral lipomas--a natural history study.

Background: Inevitable deterioration due to mechanical tethering is perceived as the natural history for complex congenital spinal lipomas of the conus medullaris region, even if asymptomatic at presentation. The conventional wisdom that prophylactic surgical untethering improves outcome has been challenged recently [1, 2]. This study examines the natural history of asymptomatic un-operated children with lumbosacral lipomas (LSL) and investigates whether predictive factors herald deterioration.

The predictive value of a repeat micturating cystourethrogram for remnant leaflets after primary endoscopic ablation of posterior urethral valves.

Objective: We routinely perform a cystourethroscopy 3 months after initial ablation of posterior urethral valves. The aim of this study was to determine the predictive value of the urethral appearance on preoperative micturating cystourethrogram (MCUG) for further valve resection at check cystoscopy.

Patients And Methods: We retrospectively reviewed 31 consecutive boys (aged 4-18 months) who underwent check cystoscopy and repeat MCUG between 2006 and 2008.

Challenges facing renal transplantation in pediatric patients with lower urinary tract dysfunction.

In pediatric patients with end-stage renal disease, renal transplantation is the established therapy of choice. The commonest cause is a congenital abnormality of the kidneys and urinary tract, often associated with lower urinary tract dysfunction (LUTD). Historically, such patients were denied transplantation, but it is now widely accepted that transplant outcomes comparable with the non-LUTD population are achievable.

Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children.

Objective: To identify whether the order of performing transplant and bladder reconstruction operations in children who need both operations affects outcome of either operation.

Patients And Methods: A retrospective case note review was performed of children identified from our database, who had undergone both renal transplantation and bladder augmentation between 1990 and 2005.

Results: In all, 18 renal transplants (eight live-related) were performed in 16 children with 10 transplants done after bladder augmentation and eight transplants done before augmentation.

A review of urodynamic evaluation in children and its role in the management of boys with posterior urethral valves.

Posterior urethral valves are the commonest cause of lower urinary tract outflow obstruction in male infants with an estimated incidence of 1:5000 male infants and 1:25,000 live births. Despite treatment with fulguration of the obstructing valves, bladder function is abnormal in up to 70% of older children and adolescents. Bladder dysfunction causes morbidity e.