SummaryAutochthonous Dirofilaria repens infections have been found in dogs and other carnivores in most European countries. In the same countries, reports of human dirofilariasis are becoming increasingly prevalent. We present 18 cases of people infected with D. repens for a 10-year period traced in our hospital. The data was collected from the observations and tests of all 18 patients from the whole country treated at the Specialized Hospital for Infectious and Parasitic Diseases in Sofia in the period 2009 – 2018. We used a morphological method, serology test and Knott’s method for microfilariae. The patients were 11 to 74 years of age, 12 female and 6 male. In most cases, patients have subcutaneous nodules or face, eyelid and eyes localization. The trend of increasing incidence in Bulgaria continues, with age and sex distribution and localization of the larva being similar to those in other European countries.

Objective: To present case of a child with epididymal dirofil­ariasis. Clinical Presentation and Intervention: An 11-year-old boy was admitted to the Clinic of Pediatric Urology for elective surgery treatment of epididymal cyst on the left side. After removal, the cyst was sent for histological examination. Microscopic examination of the histological slides revealed cross-sections of a nematode belonging to Dirofilaria spp., differentiated morphologically as D. repens. After surgery, the patient recovered completely. Conclusions: In most parts around the world, dirofilariasis is a rare and neglected infection. Nevertheless, the clinicians and pathologists must be informed about it.

Congenital diverticulum is a very rare disease of the urethra in which there is a sacculus enlargement on its ventral surface. We present a Case of a 2-year-old boy with symptoms of urinary hesitancy and swelling in the penoscrotal angle that appears during micturition. The diagnosis of urethral diverticulum is confirmed by retrograde urethrography and voiding cystogram. An open operation was performed - diverticulectomy and primary repair of the urethra.

Introduction: Pediatric urolithiasis is a very specific and challenging problem in the field of modern urology. Currently, there are three major methods for kidney stone removal: the extracorporeal shock wave lithotripsy (ESWL), the retrograde intrarenal surgery (RIRS), and the percutaneous nephrolithotomy (PCNL), the latter one proving to be an efficient and safe monotherapy of stones even with larger burden. Different sizes of nephroscopes are used (standard, mini, micro), where smaller size is logically correlated with safer profile, especially in pediatric population.Aim: To analyze the initial experience in using PCNL in children for the treatment of kidney concrements – rates of successful stone removal and registered complications.Materials and methods: Twenty-six PCNL procedures of 25 children were performed – both standard and mini. The age ofpatients, size of the stones, operating time, changes in hemoglobin levels, duration of hospital stay, and the postoperative complications were recorded, analyzed and compared to data reported in current relevant literature.Results: The mean age of patients was 9±5.2 years (15 boys and 10 girls). The average size of concrements subjected to nephrolitholapaxia was 16±0.7 mm, most of the cases being single stones. The average operative time was 150±33.4 min, and the average hospital stay was 4.1±1.5 days. The percentage of stone free children postoperatively was 94%. Complications included blood loss requiring transfusion in 1 patient (4%), postoperative urinary tract infection and fever (2 patients), and self-limiting hematuria in 16%.Conclusions: PCNL is an effective and safe alternative in the management of nephrolithiasis in children. It is a method of choice for the treatment of concretions not suitable to treat with extracorporeal lithotripsy and after a qualitative selection of patients.

Fetal urinomas are often diagnosed in prenatal ultrasonography. The etiology is usually an obstructive uropathy leading to hydronephrosis and increased intrarenal pressure putting future kidney function at risk. Rupture of pyelocaliceal system in such cases may lead to retroperitoneal urinoma or urinary ascites, sepsis, uraemia, and acute renal failure. On the other hand, this may serve as “pop-off valve” mechanism decreasing intrarenal pressure and protecting from definitive kidney function loss. We present a case of a newborn girl with a retroperitoneal urinoma, ascites, uraemia, and obstruction of a solitary right kidney, which was successfully treated minimally invasively through peritoneal and retroperitoneal drainage and intubation of the right ureter with a DJ stent shortly after birth.