OBJECTIVE:To report outcomes of a series of pediatric patients undergoing incontinent enterovesicostomy. Incontinent enterovesicostomy is a viable procedure for bladder reconstruction in pediatric patients with neurogenic bladder, but clinical outcomes data in this age group are scarce. MATERIALS AND METHODS:A retrospective chart review was conducted on pediatric patients (<18 years old) who underwent incontinent enterovesicostomy at a single institution between 2011 and 2024. Data were collected from electronic medical records and analyzed using descriptive statistics. RESULTS:A total of 26 pediatric patients (14 female, 12 male) with neurogenic bladder underwent incontinent enterovesicostomy at a median age of 12.4years (IQR: 6.4-14.0years). The median follow-up duration was 18.99months (IQR: 11.2-44.7months), and most patients (76.9%) had a primary diagnosis of myelomeningocele. Indications for surgery included recurrent urinary infections, urethral incontinence, and bladder hostility. The median operative time was 241.5 minutes (IQR: 192-273 minutes), and the median hospital stay was 5days. Within 30days postsurgery, 76.9% of patients experienced no complications. Renal function remained stable in all patients, and hydronephrosis status worsened in only 1 patient. CONCLUSION:Enterovesicostomy is a safe, feasible, and effective surgical option for managing neurogenic bladder in pediatric patients. It reliably treats bladder hostility and protects upper urinary tract function with a low complication rate. Future research should focus on prospective, multicenter studies comparing long-term outcomes of incontinent enterovesicostomy with augmentation cystoplasty.

Objective: To report diagnosis, treatment, and outcomes of vaginal yolk sac tumor (YST) cases at a single institution and review literature on vaginal YST to outline advancements in diagnosis, treatment, and survival. Design: Retrospective chart review of female patients less than 21 years of age with pathologic diagnosis of vaginal YST treated at a large children's hospital, and summary of a 100-year review of the literature on vaginal yolk sac tumor. Setting: Children's Healthcare of Atlanta, a tertiary center in Atlanta, GA. Participants: Female patients less than 21 years of age diagnosed with vaginal YST. Results: Two cases of vaginal YST at our institution are outlined. Both patients presented within the first 2 years of life with vaginal bleeding and were treated successfully with chemotherapy alone. After review of the literature, 137 cases of vaginal YST were found. The mean age at diagnosis was 11 months, and all patients presented with vaginal bleeding. Before 2000, more radical treatments were pursued, and 40% resulted in death. Since the year 2000, treatment has shifted toward chemotherapy and more conservative surgical management, with 51% of vaginal YST cases treated with chemotherapy alone with 92% of patients alive at time of publication. Conclusion: Our cases contribute to the limited literature demonstrating the efficacy of conservative management of rare cases of vaginal YST with chemotherapy alone. This case series and review of the literature provide mounting evidence that vaginal YST should be in the differential diagnosis in young girls with vaginal tumors, and conservative management of vaginal YST has excellent outcomes.

PURPOSE:Adrenal trauma in children is rare and poorly characterized. To characterize these injuries better, we reviewed the contemporary experience at a large pediatric trauma center.MATERIALS AND METHODS:We queried the trauma registry of Children's Hospitals of Atlanta for all patients treated for adrenal trauma (ICD-9 codes 868.01 and 868.11) between January 1, 2000 and December 31, 2009. We performed a detailed chart review.RESULTS:Of 12,045 patients who were treated for trauma during the study period 42 children (0.35%) with adrenal injuries were identified. All injuries resulted from blunt trauma. Motor vehicle crash was the most common mechanism, responsible for 41% of injuries. A total of 41 cases (98%) were diagnosed by computerized tomography and 1 during exploratory laparotomy for associated vascular injury. Injuries were to the right adrenal gland in 36 cases (86%), left in 5 (12%) and bilateral in 1 (2%). The most common associated regions were the liver (55%), head or brain (33%) and skeleton (31%). Five patients (12%) experienced isolated adrenal injuries. One patient required treatment for adrenal insufficiency and none required adrenalectomy, adrenalorrhaphy or adrenal embolization. Of patients with isolated adrenal injuries 2 were hospitalized and 3 were treated as outpatients. All had an unremarkable course.CONCLUSIONS:Adrenal trauma in children is rare. Although typically associated with high morbidity, this outcome is likely from related injuries as an isolated adrenal injury generally portends a benign course.

A fetus with severe infravesical obstruction displays characteristic findings on prenatal ultrasound (that is hydronephrosis, hydroureter, bladder distention, prostatic urethral dilatation and oligohydramnios). The most common cause of infravesical obstruction in a fetus is posterior urethral valves, which were first classified by Young et all and are hypothesized to be mesonephric duct remnants.(2) We report a case of similar prenatal ultrasound findings in a full term male whose amniotic fluid level normalized in the third trimester and who was found to have a congenital urethral stricture.

Tuberous sclerosis is an autosomal dominant neurocutaneous disease that affects 1 in 6,000 individuals, with up to two-thirds of the cases being sporadic.(1) The tuberous sclerosis complex frequently manifests as renal lesions, the most common being angiomyolipoma, which is found in up to 80% of the cases.(2) Patients are also at increased risk for renal cell carcinoma, with an onset 20 to 30 years earlier than in the general population and bilateral disease in up to 43% of the cases.(3) To our knowledge we report on the youngest individual to have renal cell carcinoma in the setting of the tuberous sclerosis complex.