Explore the vast range of titles available.

Introduction: There is no well-accepted guideline or uniform practice for the usage of prophylactic antibiotics along with urethroplasty for hypospadias. As antibiotic resistance is growing, it is imperative to rationalize the usage of antibiotics when a patient is operated for hypospadias. Aims and Objectives: The study is aimed at finding if there is any difference in outcome if prophylactic antibiotics are given after urethroplasty for hypospadias. Study Design: Prospective randomized controlled study. Material and Methods: Forty patients between 6 months and 12 years of age were included in the pilot study. All patients received a single preoperative antibiotic and surgery as per the discretion of the operating surgeon. The participants were randomly assigned to Group A or B, Group A not receiving any prophylactic antibiotic after surgery, and Group B receiving prophylactic antibiotics till indwelling urethral catheter was in situ as per the present antibiotic policy of the institute. The patients were followed up clinically at catheter removal, 1 week after surgery and 1 month after surgery. Urine was analyzed at the start of surgery and after catheter removal. Data were tabulated and analyzed using nonparametric Fischer's exact test with help of Epi Info™ v5.5.8. Results: Twenty-four patients were included in Group A and 16 in Group B. The clinical profile is presented in the detailed manuscript. Although pus cells could be demonstrated on urine examination in 82.5% of the study participants, only 10% grew organisms on culture media. No difference could be demonstrated among the two groups statistically. On following up with the patients for 1 month, the groups were comparable with respect to surgical site infections, and surgical complications such as urethrocutaneous fistula/dehiscence and thin stream. Discussion: There was a wide variability among practicing pediatric urologists in prescribing antibiotic prophylaxis for patients undergoing urethroplasty for hypospadias. In the Urologic Surgery Antimicrobial Prophylaxis Policy by the American Urology Association, no recommendation has been made with respect to urethroplasty. Our results are in concurrence with the available English literature which has not shown any benefit of prophylactic antibiotics after hypospadias repair. Conclusions: Antibiotics may not have a definite role in the prevention of surgical complications and it may be imperative to avoid unnecessary antibiotics to reduce antibiotic resistance.

Introduction: Colorectal carcinoma (CRC) accounts for <1% of all the neoplasms of children. Unfavorable histology and delayed diagnosis often result in poor outcome. This study aimed to investigate the clinical characteristic and prognosis of pediatric patients with CRC. Materials and Methods: A retrospective review of medical records of all patients diagnosed of CRC between 2015 and 2020 was performed. Data regarding gender, age, location, and histopathology were collected. Results: Seven children (5 males and 2 females) were included in the study. Age ranged between 8.6 and 11.8 years. Abdominal pain was the most common symptom. The duration between onset of symptoms to the diagnosis ranged from 5 days to 8 months. Right-sided tumors were more common than the left side. Histopathological examination showed mucinous adenocarcinoma in four/seven patients and signet cell variant was seen in 2/7. Immunohistochemistry was positive for cytokeratin and beta-catenin, however, all microsatellite instability markers were found negative. Despite surgical treatment and chemotherapy, four of our cases faced mortality and one patient was lost to follow-up. Conclusion: CRC can present in first decade of life and often misdiagnosed. Pediatric CRC has distinct tumor biology and shares a poor prognosis. Paucity of literature from the Indian subcontinent should urge further clinicopathological trials for establishing etiology and for refining treatment recommendations in these children.

Introduction: Incidence of pediatric urolithiasis has increased over the last few decades. Procedures such as extracorporeal short wave lithotripsy, percutaneous nephrolithotripsy, and ureterorenoscopic lithotripsy are not widely available for pediatric age group in many developing countries. It is desirable that advantages of minimally invasive surgery be offered to selected cases with urolithiasis. Materials and Methods: All patients with pediatric upper tract urolithiasis managed laparoscopically from January 2015 to April 2020 were retrospectively reviewed. Results: A total of 38 patients were included. The mean age of the patients was 8 ± 2.85 years. Thirty-four patients (renal and upper ureteric) were managed through retroperitoneal approach, while those with lower ureteric calculi (n = 4) were approached transperitoneally. A total of eight patients required conversion to open technique. The stone clearance rate was 79% by laparoscopic approach alone. There were no procedure-related complications. Conclusion: Our study suggests that laparoscopic management for pediatric upper tract urolithiasis is a radiation-free, single-time curative treatment and is feasible in centers where facilities for other endoscopic procedures are unavailable.

Background: Mortality in surgical neonates contributes to neonatal mortality rates. The study was conceptualized to study clinical and nonclinical factors affecting mortality in surgical neonates so that timely intervention could result in improved survival of the neonates. Materials and Methods: The study was initiated after approval from the institutional ethics committee and included 120 surgical neonates over a period of 18 months after obtaining consent from the parents/caregivers. Predesigned pro forma was used to record the details of antenatal care received, place of birth, travel history, maternal education and gestational age, and clinical condition at the time of admission. Values of biochemical tests such as serum electrolytes, serum creatinine, and arterial blood gasses were recorded. The need of inotrope support, blood or blood product transfusion, and postoperative ventilator support and intensive care unit (ICU) care was recorded. The results of the two groups, i.e., survivals and mortality, were compared. Outcome was recorded as mortality at 30 days or earlier. Results: Irrespective of the surgical condition, the survival rate was significantly better in those babies who weighed more than 2.5 kg at the time of admission, had capillary refill time of <3 s, had serum ionized calcium levels more than 1 mmol/L, and did not require inotropes, blood or blood product transfusion, and postoperative ICU care and ventilator support. The place of birth, educational status of the mother, gestational age, and distance traveled for care had no statistically significant effect on survival. Conclusion: There is a statistically significant correlation between the survival of the babies who weighed more than 2.5 kg and are more physiologically preserved at the time of admission. Mortality rates can be decreased by timely interventions to reduce the need of inotropes, blood or blood products, and ICU care and ventilator support during their postoperative recovery.

Introduction: Prostatic utricles (PUs) are the remnants of Mullerian ducts found in the male posterior urethra. Enlarged symptomatic utricles are known to be associated with hypospadias. There is a dearth of literature defining an enlarged utricle and also its clinical significance. Aims: The aim of this study was to describe anatomical difference of PUs of cases with severe hypospadias and also to find their clinical significance if any. Materials and Methods: A prospective study was carried out, and all patients with proximal hypospadias were enrolled. Cystoscopy was performed in all cases. Symptomatology, size, and location of PU were recorded. PU of >0.5 cm was considered enlarged. Results: In the present series, a total of 70 cases were included over a period of 2 years. Enlarged utricle was found in 47/70 (67.14%) on cystoscopy. They were wide-mouthed and negotiated 9 Fr/11 Fr cystoscope with ease. Recurrent epididymo-orchitis, recurrent urinary tract infection, and obstructive features were the most common complications requiring intervention. Conclusions: PUs in boys with hypospadias are enlarged as well as wide-mouthed. Most of these remain asymptomatic, but few of them carry the potential of complications. Cystoscopy helps in direct visualization of utricular anatomy, so it should be a preferred investigating modality for investigating a PU.

Foregut cystic developmental malformations (FCDM) are a type of rare cystic lesion. The occurrence of FCDM is exceedingly uncommon in the intraoral location. We report three cases of FCDM with intraoral location who presented at Chacha Nehru Bal Chikitsalaya, New Delhi, India, in 2016, 2017 and 2018 with symptoms of respiratory distress and feeding difficulties. Two patients were male and one was female with an age range of 29 days to eight years. The clinical differential diagnosis included mucocele, ranula, dermoid, lymphangioma, teratoma, thyroglossal duct cyst, etc. All patients were treated with simple surgical excision and diagnosed, based on histopathology, with FCDM. These should be considered as differential diagnosis of head and neck midline cystic mass lesions. This case report aimed to discuss differential diagnosis and appropriate terminology for these cystic masses as there is varied and ambiguous nomenclature.

BackgroundThere are multiple causes of bleeding per rectum in children. We present here a rare case of bowel arterio-venous malformation causing lower GI bleed and its management.Methods and ResultsA toddler presented with multiple episodes of bleeding per rectum. Digital rectal examination was within normal limits. A colonoscopy revealed flares in mucosa of colon. CT scan showed slow-flow vascular malformation and the child was initially managed with daily peglec and propranolol with partial response. After two episodes of life-threatening bleeding PR, the child was planned for exploration which revealed a hypervascular appendix (IDDF2022-ABS-0283 Figure 1. Hypervascular appendix with multiple lease of vessels) and congested sigmoid colon (IDDF2022-ABS-0283 Figure 2. Vascular malformation of sigmoid colon), with vascular malformation getting a feeder from the inferior mesenteric vessel, which was ligated (IDDF2022-ABS-0283 Figure 3. Ligated vessel of AVM) and appendix sent for histology. HPE showed it to be an AVM. The child is doing fine in the follow-up period.Abstract IDDF2022-ABS-0283 Figure 1Abstract IDDF2022-ABS-0283 Figure 2Abstract IDDF2022-ABS-0283 Figure 3ConclusionArterio-venous malformation of the bowel should be kept as a rare differential in lower GIT bleeding cases.

BackgroundMedical science is known to have many exceptions. When it comes to the liver, the exception is the rule. It may have n number of atypical anatomy. We present here a rare case of umbilico-bilious fistula and its management.MethodsAn infant presented with umbilical sepsis. In due course of admission, the umbilical skin got denuded, exposing the underlying bowel with bile staining. The baby was taken for exploratory laparotomy with suspicion of bowel perforation, but to our surprise whole gastro-intestinal tract was intact, with some bile staining near the lesser sac.ResultsOn further search, the umbilical ligament was found to have rent near the liver surface with bilious discharge. (IDDF2022-ABS-0281 Figure 1. Intra-operative picture of bilious discharge from umbilical ligament) A 6 Fr Foley catheter was inserted into the tract for future contrast study, which revealed communication to the biliary tree. (IDDF2022-ABS-0281 Figure 2. The contrast study showing fistulous communication with biliary tree) The tract was ligated.Abstract IDDF2022-ABS-0281 Figure 1Abstract IDDF2022-ABS-0281 Figure 2ConclusionUmbilico-bilious fistulization is a rare presentation of umbilical sepsis. It should be kept in mind while dealing with umbilical sepsis cases.

BackgroundDouble ani with colonic duplications is quite rare. It has a female preponderance. We present here a rare case of total colonic duplication with one normal and one imperforate anus terminating into the vestibule and its management.Methods and ResultsA 6-years-old female child presented with a history of fecal discharge from introitus. Initially, a diversion stoma was made. Figure 1 (IDDF2022-ABS-0282 Figure 1. 4 divided stomas) shows 4 stomas of the duplicated colon. Perineal examination revealed normal urethral opening, septate vagina and vestibular fistula (IDDF2022-ABS-0282 Figure 2. Perineal examination showing normal urethral opening, septate vagina and vestibular fistula with normal anal opening). During definitive surgery, the vestibular fistula was mobilized, common wall was divided, end closed and perineal wall was reconstructed. At the time of stoma reversal, both proximal and distal limb common walls were divided with a stapler and bowel continuity was restored.Abstract IDDF2022-ABS-0282 Figure 1Abstract IDDF2022-ABS-0282 Figure 2ConclusionPediatric surgeons should keep ‘double ani with colonic duplications’ in mind while dealing with imperforate anus malformations.

Objective To assess the long-term urinary continence of patients operated for isolated female epispadias using novel approach of distal urethral lengthening along with the incorporation of deeper periurethral muscles over the native urethra. Occurrence of UTI and stress incontinence too were assessed as secondary outcomes. Methodology All girls diagnosed with isolated female epispadias, who underwent epispadias repair, and completed follow-up period of minimum 2 years, were included in this study. Their long-term continence was assessed using a validated questionnaire. The study group patients underwent distal urethroplasty using hairless skin of mons along with incorporation of deep periurethral tissue. Bladder neck reconstruction was added in initial patients with minor variant (type 2 of Davis classification) and in patient with cleft extending till bladder neck (type 3 of Davis classification). Five of the patients with type 2 defects were managed only with urethroplasty. Results At a mean follow up of 7.4years all patients with type 2 epispadias (Davis classification) are continent and void on desire. None of them are having UTI or stress incontinence. Patient with type 3 epispadias is incontinent with dry interval of less than 30 min and awaiting augmentation cystoplasty. Conclusion Simple urethral reconstruction with inclusion of hairless skin over mons and deeper peri-urethral soft tissue might be sufficient to restore sphincteric function in minor variants of isolated female epispadias. More extensive procedures may be reserved for the most severe cases.