Conservative approach for the treatment of urethral prolapse in children: case report and literature review of 278 pediatric cases

Abstract Background Urethral prolapse (UP) is a rare, benign condition that often goes misdiagnosed and mistreated. It consists of the eversion of the distal urethral mucosa through the outer urethral meatus, leading to vascular obstruction and prolapsed tissue edema, which aggravates the prolapse. Although many review articles were reported on this condition, none of them focused on the conservative approach nor targeted the pediatric population. In this paper, we present successful medical management of UP in a 13-month-old Caucasian female and perform an extensive review of the literature to include articles that reported a conservative approach in patients under 18-years-old. We also suggested a practical algorithm for both diagnosis and management of this condition. Case presentation A 13-month-old Caucasian white female was presented with a urinary tract infection and vaginal bleeding. Genital examination showed a hyperemic donut-shaped mass covering the urinary meatus, of 0.7 cm diameter, with an actively bleeding open center. After confirming the diagnosis of UP with catheterization, a conservative approach was decided; antibiotics associated with topical corticosteroids including betamethasone 1% cream. The first-week outcome showed regression of the prolapsed tissue and the examination after four months showed normal vaginal mucosa with no evidence of relapse. Conclusions 20 studies were retained after PubMed search with a total of 278 female patients aged between 1 month and 15 years old. The main reasons for referral were vaginal bleeding and mass, urinary symptoms followed by sexual abuse. Non-surgical treatment was tried for 162 patients. 53 of them were successfully managed, while 92 reported unsuccessful outcomes. The conservative approach was successful in 19% of all patients and raised to 32.7% in the portion of children selected for the initial conservative approach. Even though this review showed good results with medical treatment in children with UP, additional comparative studies are required to evaluate the effectiveness of conservative treatment in comparison with surgical interventions. In addition, Long-term follow-up is required as recurrence was reported up to 2 years following conservative treatment.

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Effect of childhood overweight on distal metaphyseal radius fractures treated by closed reduction

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02336-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yu Liu ◽

Chunjie Liu ◽

Dongmei Guo ◽

Ning Wang ◽

Ying Zhao ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Conservative Treatment ◽

Closed Reduction ◽

Pediatric Population ◽

Normal Weight ◽

Medical Community ◽

Overweight Children ◽

Radius Fractures

Abstract Background The medical community has recognized overweight as an epidemic negatively affecting a large proportion of the pediatric population, but few studies have been performed to investigate the relationship between overweight and failure of conservative treatment for distal radius fractures (DRFs). This study was performed to investigate the effect of overweight on the outcome of conservative treatment for DRFs in children. Methods We performed a retrospective study of children with closed displaced distal metaphyseal radius fractures in our hospital from January 2015 to May 2020. Closed reduction was initially performed; if closed reduction failed, surgical treatment was performed. Patients were followed up regularly after treatment, and redisplacement was diagnosed on the basis of imaging findings. Potential risk factors for redisplacement were collected and analyzed. Results In total, 142 children were included in this study. The final reduction procedure failed in 21 patients, all of whom finally underwent surgical treatment. The incidences of failed final reduction and fair reduction were significantly higher in the overweight/obesity group than in the normal-weight group (P = 0.046 and P = 0.041, respectively). During follow-up, 32 (26.4%) patients developed redisplacement after closed reduction and cast immobilization. The three risk factors associated with the incidence of redisplacement were overweight/obesity [odds ratio (OR), 2.149; 95% confidence interval (CI), 1.320–3.498], an associated ulnar fracture (OR, 2.127; 95% CI, 1.169–3.870), and a three-point index of ≥ 0.40 (OR, 3.272; 95% CI, 1.975–5.421). Conclusions Overweight increases the risk of reduction failure and decreases the reduction effect. Overweight children were two times more likely to develop redisplacement than normal-weight children in the present study. Thus, overweight children may benefit from stricter clinical follow-up and perhaps a lower threshold for surgical intervention.

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Pierwotna małopłytkowość immunologiczna u dzieci

Nowa Pediatria ◽

10.25121/np.2018.22.4.122 ◽

2018 ◽

Vol 22 (4) ◽

Author(s):

Anna Dusza ◽

Michał Matysiak

Keyword(s):

Immune Thrombocytopenia ◽

Clinical Symptoms ◽

Pediatric Population ◽

Current Data ◽

Current Investigation ◽

Surgical Interventions ◽

Hematological Disorders ◽

Primary Immune Thrombocytopenia

In this article we present current investigation on primary immune thrombocytopenia in children. There are described pathomorphology, clinical symptoms, diagnosis and treatment. We also present current data from literature about genetic tests and latest data on treating options in children. Primary immune thrombocytopenia (ITP) is one of the most frequent hematological disorders in pediatric population. Although the majority of children have a self-limited and short duration of the disease. However, approximately 20-30% of those patients can develop chronic ITP, which can cause significant complications and higher mortality and reduced quality of life. Especially regarding to long-term immunosupression or surgical interventions, such like splenectomy and restrictions on daily activities to avoid trauma. Over the past decades a lot of informations has been reported about pathogenic features of ITP. Nowdays, we know that it is not only caused by increased platet destruction and decreased platet production, but also complex, multifactorial immune dysregulation, like loss of immune tolerance and generation of platelet autoantibodies. In this article we present current investigation on ITP including clinical symptoms, diagnosis, pathomorphology and latests options on treatment in children. We also present current data about genetic biomarker, such as Vanin-1 (VNN-1) which has been suggested as one of predictors of chronic disease and potentially can offer early prognosis estimation.

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Surgical treatment of acute abscesses and gangrene of the lungs

Kazan medical journal ◽

10.17816/kazmj59786 ◽

1982 ◽

Vol 63 (1) ◽

pp. 28-31

Author(s):

E. A. Wagner ◽

V. M. Subbotin ◽

V. D. Firsov ◽

V. A. Cherkasov ◽

V. I. Ilchishin ◽

...

Keyword(s):

Surgical Treatment ◽

Conservative Treatment ◽

Surgical Interventions

Abstract. The experience of treating 263 patients with acute abscesses and lung gangrene is generalized. Acute abscesses are mainly subject to conservative treatment; surgical interventions were performed in 13%. With gangrene of the lung, conservative treatment and palliative operations are futile. Preference is given to early radical operations performed before dangerous complications occur. Possible ways to reduce mortality in acute pulmonary suppuration are indicated.

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A case report of urethral prolapse in a 38 year old female with 46XY karyotype

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2014.2.140 ◽

2014 ◽

Vol 86 (2) ◽

pp. 140 ◽

Cited By ~ 1

Author(s):

Helena Watson ◽

Ewa Stasiowska

Keyword(s):

Replacement Therapy ◽

Vaginal Bleeding ◽

Hormone Replacement ◽

Androgen Insensitivity Syndrome ◽

Acute Onset ◽

Premature Menopause ◽

Complete Androgen Insensitivity Syndrome ◽

Younger Women ◽

Urethral Prolapse

A 38-year old female presented with the acute onset of a vulval mass associated with pain and vaginal bleeding. She is female phenotype but has 46XY karyotype and Complete Androgen Insensitivity Syndrome (CAIS). At 15 years old she had a laparotomy and bilateral orchidectomy. Following admission, an examination under anaesthesia and cystoscopy was performed. A diagnosis of strangulated complete urethral prolapse was made. The lesion was excised with diathermy and the meatal skin was reanastomosed to the urethra. At follow-up, the urethra was well healed. The patient now attends Menopause Clinic for oestrogen-replacement therapy. We hope this case raises awareness of the possibility of urethral prolapse in younger women who are oestrogen deficient. It provides further incentive for compliance with hormone replacement therapy for patients with CAIS following gonadectomy, or other women with premature menopause.

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Shunting of congenital hydrocephalus in children

Bulletin of Science and Practice ◽

10.33619/2414-2948/39/14 ◽

2019 ◽

Vol 5 (2) ◽

pp. 103-108

Author(s):

S. Abdykerimov ◽

D. Kochkunov

Keyword(s):

Conservative Treatment ◽

Computerized Tomography ◽

Early Treatment ◽

Abdominal Cavity ◽

Drainage System ◽

Subsequent Treatment ◽

Congenital Hydrocephalus ◽

Surgical Interventions ◽

Ventriculoperitoneal Shunting ◽

Tomography Scan

The paper analyzes the results of ventriculoperitoneal shunting operations in the treatment of congenital hydrocephalus in 55 patients aged 3 months up to 3 years. There were 37 boys and 18 girls who underwent various types of shunting operations after the failure of conservative treatment. Retrospectively, by the nature of the performed surgical interventions, the patients were divided into two groups: the first group included 25 children with congenital forms of cerebral dropsy, where ventriculoperitoneal shunting is performed with fixation of the distal shunt by separate sutures into the abdominal cavity; the second group included 30 children of similar ages, who underwent ventriculoperitoneal shunting without fixation by creating a tunnel and two, three holes fixing it. By studying the nature and causes of occlusive syndromes, the authors modified the method of shunting operations, which proved its rationality and effectiveness. In the scientific–grounded causes of occlusion of shunt catheters and methods for their correction. Dynamics with the use of neurosonography and MRI are recommended for detection and early treatment of disturbed shunt conditions. The most dangerous complication hyperdrainage detected during the operation was the formation of hydromas. To prevent the development of this pathology, it is enough to put the patient on the bed with the lowered head end. For the detection and subsequent treatment of conditions associated with dysfunction of the shunt required regular re not, with the spuriousness of this method is the computerized tomography scan or MRI. It is very important to have a conversation with the parents of the child who underwent shunting operations about the properties of the drainage system, the nature of possible complications and tactics of behaviour that allows you to timely provide the necessary assistance to patients.

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Methods of approach то diagnostics and conservative treatment of papillomaviral infection

Journal of obstetrics and women s diseases ◽

10.17816/jowd88661 ◽

2004 ◽

Vol 53 (4) ◽

pp. 62-68

Author(s):

Konstantin V. Minkevich ◽

Vladislav G. Yakovlev ◽

А. N. Kucheryavenko

Keyword(s):

Conservative Treatment ◽

Uterine Cervix ◽

Hpv Infection ◽

Vaginal Mucosa

Causes of development of HPV infection and its role in pathology of the woman's genital organs are analysed in the article. The up-to-date methods for diagnostics and treatment of this infection are given. Special attention is paid to the revealing of this pathology in the vulva, vaginal mucosa and uterine cervix. The text is illustrated with figures. Recommendations are given to treat patients when HPV infection is detected.

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Feasibility of the New Zealand white Rabbit as an Animal Model for the Study of Biological Grafts in the Pelvic Floor Dysfunctions

10.21203/rs.3.rs-127116/v1 ◽

2020 ◽

Author(s):

Marta Peró Garcia ◽

Laura Casani Arazo ◽

Cristina Castells-Sala ◽

Maria Pérez Rodríguez ◽

Maria Moga Naranjo ◽

...

Keyword(s):

New Zealand ◽

Reconstructive Surgery ◽

Zealand White Rabbit ◽

Vaginal Surgery ◽

Vaginal Mesh ◽

White Female ◽

Control Group ◽

Vaginal Mucosa ◽

Pelvic Reconstructive Surgery ◽

Dermal Matrix

Abstract Objective: to investigate the feasibility of the New Zealand White (NZW) rabbit to study human acellular dermal matrix (hADM) biomaterials in pelvic reconstructive surgery. Study design: 20 white female NZW rabbits were randomized into 2 groups, the experimental group (hADM graft) and the control group (Polypropylene graft; PP). In each animal, grafts were surgically implanted subcutaneously in the abdominal wall and in the vaginal submucosa layer for 180 days. The graft segments were then removed and the surgical and clinical results were analysed. Results: The main surgical challenges were: a) to obtain the adequate vaginal exposure and the maintenance of the integrity of the vaginal mucosa layer; b) to keep aseptic conditions; c) to locate and dissect the breast vein during abdominal surgery; and, d) to withdraw blood samples from the ear artery. The most abnormal findings during the explant surgery were found in the PP group (33% of vaginal mesh extrusion) in comparison with the hADM group (0% of vaginal graft extrusion), p=0.015. Interestingly, macroscopic observation indicated that the integration of the vaginal grafts was more common in the hADM group (40%) than in the PP group, in which the vaginal mesh was identified in 100% of the animals (p=0.014). Conclusions: The NZW rabbit is an excellent model to assess materials to be used as grafts for pelvic reconstructive surgery and vaginal surgery. Animals are easily managed during the procedures, including the surgical intervention and vaginal mucosa handling.

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Management of gestational gigantomastia with breast reconstruction after mastectomy: case report and literature review

Journal of International Medical Research ◽

10.1177/0300060520920463 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052092046

Author(s):

Feng Qin ◽

Loubin Si ◽

Hailin Zhang ◽

Mingzi Zhang ◽

Ang Zeng ◽

...

Keyword(s):

Medical Therapy ◽

Rare Complication ◽

Tissue Expander ◽

Benign Condition ◽

Surgical Interventions ◽

Nipple Areola Complex ◽

Areola Complex ◽

First Choice ◽

Initial Procedure ◽

Delayed Reconstruction

Gestational gigantomastia (GGM) is a rare complication of pregnancy. The etiology of GGM is yet to be fully established. Treatment methods for GGM include medical therapy and surgery. If medical treatment is unsuccessful, surgery may be required. Currently available surgical interventions are either breast reduction or mastectomy with delayed reconstruction. We report a case of a 25-year-old woman (G1P1) who presented with massive enlargement of both breasts during puerperium. Because of the limited effect of medical therapy, surgical intervention was considered to be the first choice. Bilateral mastectomies with grafting of the nipple–areola complex and immediate bilateral tissue expander implantation were performed. Reconstruction was fully completed 8 months after the initial procedure by replacing tissue expanders with definitive implants. Despite being a benign condition, GGM can turn into a serious problem. GGM can be successfully reconstructed by mastectomy with delayed reconstruction and grafting of the nipple–areola complex.

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A Conservative Surgical Approach to the Treatment of Optic Disc Pit Maculopathy: Four Case Reports

Case Reports in Ophthalmology ◽

10.1159/000507880 ◽

2020 ◽

Vol 11 (2) ◽

pp. 196-204

Author(s):

Emilio Rapizzi ◽

Paola Gallon ◽

Diego Ponzin ◽

Stefano Ferrari ◽

Nicola Zemella

Keyword(s):

Optic Disc ◽

Case Reports ◽

Posterior Vitreous Detachment ◽

Subretinal Fluid ◽

Internal Limiting Membrane ◽

Conservative Approach ◽

Optic Disc Pit ◽

Surgical Interventions ◽

Optic Disc Pit Maculopathy ◽

Intravitreal Gas

The purpose of this report is to present the outcomes of surgical interventions in 4 patients with maculopathy associated with optic disc pit (ODP). We report 4 cases of patients affected by ODP maculopathy and treated by core vitrectomy with induction of posterior vitreous detachment and peeling of the internal limiting membrane restricted to the interpapillary macular zone without laser treatment and gas tamponade. The patients had rapid resolution of the multilayer inner retinoschisis-like separation and progressive slow reabsorption of the macular intraretinal and subretinal fluid up to complete retinal reattachment. Currently, there are still no widely accepted guidelines related to the best technique in the management of the maculopathy associated with ODP. We used a conservative approach, without the adoption of intravitreal gas injection or laser.

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