Background: We prospectively evaluated the oncological and renal functional outcomes of children with unilateral Wilms' tumor (WT) undergoing nephron-sparing surgery (NSS) versus ablative nephrectomy. Materials and Methods: Children presenting with unilateral WT from January 2006 to December 2015 were prospectively randomized to undergo either ablative (simple/radical) nephrectomy or NSS. Treatment was administered according to the Societe Internationale d'Oncologie Pediatrique-2001 protocol. Results: During the 10-year study period, 13 children underwent ablative nephrectomy, and 15 underwent NSS (partial nephrectomy/wedge excision). The contralateral kidneys were found to be normal on ultrasonography and computed tomography imaging. The mean age at intervention was 44.8 ± 16.7 months. Eight children presented with Stage I disease and the remaining 20 had Stage II disease. The mean follow-up period was 53. 68 ± 23.82 months and all children were alive at the last follow-up without any clinical evidence of disease. The event-free survival rates were 100% and 92.3% in the children undergoing NSS and ablative nephrectomy, respectively. The children who underwent ablative nephrectomy presented with considerably higher mean systolic and diastolic blood pressures, as well as significantly elevated mean values of serum creatinine compared to their ablative nephrectomy counterparts. Conclusion: The oncological outcome of NSS was as good as ablative nephrectomy in children with unilateral WTs. NSS also minimized the loss of renal function.
Introduction: Complex renal cystic lesions have long posed a clinical dilemma to clinicians as they represent a heterogeneous group of both benign and malignant conditions sharing similar clinical and radiological features. The Bosniak classification system based on computed tomography (CT) imaging remains the gold standard to predict the risk of malignancy in cystic renal masses. We retrospectively reviewed our series of patients who underwent surgery for renal cysts, their histopathological diagnosis, the outcome of surgery, and follow-up. Materials and Methods: We retrospectively reviewed the inpatient charts of the hospital for patients with renal cysts undergoing surgery for the same during the period January 2000-December 2017. CT images of these patients were re-reviewed. Clinical, surgical, radiological, pathological, and postoperative outcomes were analyzed. Based on the final pathology findings, the patients were stratified into a renal cell carcinoma (RCC) or a benign tumor subgroup. Results: During the 18-year study period, 31 patients with Bosniak I simple renal cysts, 23 with Bosniak 2 cysts, 1 patient with Bosniak IIF cyst, 8 with III cyst, and 11 with IV cyst underwent surgery. None of the patients with Bosniak I, II, and IIF had malignancy on histopathological examination (HPR) of the resected cyst wall. Five of the eight patients with Bosniak III and all 11 patients with Bosniak IV cysts had malignant lesions. Histopathological variety of RCC was clear cell type with Fuhrman Grade 1–2 in all the 16 patients. None of the patients have had either local or systematic recurrence of the malignancy. Five patients died during the follow-up period due to causes other than malignancy. Conclusions: Patients with unifocal cystic RCC evaluated and managed using standard imaging carry an excellent prognosis. Bosniak classification system is very effective in predicting malignancy in categories II, IIF, and IV, but low in category III, and that 37.5% of Bosniak III cysts were benign on HPR.
Introduction: We report our results of preputial flap onlay urethroplasty for the one-stage repair of mid- and proximal penile hypospadias with chordee.Materials and Methods: We retrospectively reviewed the hospital data base for children undergoing onlay flap urethroplasty and hypospadias repair for mid- or proximal penile hypospadias with chordee.Results: During the study period January 2000–December 2017, 21 children underwent onlay preputial flap urethroplasty. The procedure was successful in 15 (71.42%) children with no need to undergo further procedures or operations. There were five urethrocutaneous fistulas and dehiscence of glans in one.Conclusions: An onlay urethroplasty using the preputial flap yields results comparable to those of staged techniques and results in fewer procedures under anesthesia in children.
Verrucous lesions of the penis are rare and difficult to classify. Superficial biopsy in any of the verrucous lesions shows only hyperkeratosis, acanthosis, and papillomatosis. Therefore, an adequate biopsy is a must to show the rete pegs that extend into the deeper tissues. Deeper biopsies are always required for an accurate diagnosis. These nonneoplastic lesions of the penis need to be differentiated from cancer which is associated with high morbidity. We report a case of a verrucous lesion of the penis in a 38-year-old male.
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