Operative cystoscopy in the neonatal period

Abstract

Aim of the study is to report the experience in the last three years about endourological treatment of newborns affected by genito-and urinary malformation, implying critical urinary tract dilatation and bladder mass requiring a neonatal operative management. Sevenfour males and three female -patients were treated cystoscopically during the neonatal period. Three newborns with a posterior urethral valves (PUV), underwent a successful ablation of PUV. In a male with infected persistent large mullerian duct and subsequent acute urinary retention, a cystoscopically-assisted catheterization was performed. Two females, one with cloaca and the other with high persistent urogenital sinus and massive associated hydrometrocolpos underwent a cystoscopical drainage of the vagina and a positioning of a balloon catheter into the bladder. Another female with a bladder mass had a endoscopical biopsy. Thanks to modern neonatal operative urethrocystoscope, today is possible to treat early many pathological genito-urinary conditions in newborns.

Hydrometrocolpos in a newborn

“…Кисты яичников, как правило, располагаются латеральнее по отношению к матке и влагалищу. При диагностических трудностях возможно проведение магнитно-резонансной томографии [3,5,[8][9][10]14,15].…”

“…Как правило после дренирования ГМК восстанавливается пассаж кишечного содержимого и нивелируются признаки обструкции мочевыводящих путей. В случаях, когда ГМК является одной из составляющих урогенитального синуса или персистирующей клоаки (IV, V тип), для радикальной коррекции требуются большие реконструктивно-пластические вмешательства [1-3,10-12, [14][15][16].…”

Pathogenesis and prognosis of intrarenal reflux

“…Most cases of vesicoureteral reflux (VUR) are detected pre-symptomatically either by investigating remaining congenital hydronephrosis or in the context of a preventive examination [1,2]. Scar development as a consequence of VUR can be detected from the intrauterine period of life (fetal reflux nephropathy -FRN) [3].…”

“…In addition, due to intrauterine VUR, increased intraluminal pressure develops in the urinary tract, with a consequent harmful effect on the developing metanephros [6][7][8]. During the initial diagnostic evaluation of children with VUR, scars are found in the renal cortex and especially in the poles in 30-50% of cases [3].…”

“…From an etiological point of view, the development of scars in the cortex of the kidneys has been associated with: a) the form of the renal papilla [3]: Normally the renal papilla has a conical shape. The orifices of the collecting ducts that exit on the surface of these conical papillae have a lateral direction so that their walls coincide, when exerting increased intra-calyceal pressure, in order to prevent IRR.…”