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Congenital anterior urethral diverticulum in children
1Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi.
Insights
Congenital anterior urethral diverticulum (CAUD) in children often presents as penile swelling or urinary issues. Primary surgical repair is the preferred treatment, with conservative management suitable for cases involving obstructive uropathy or vesicourethral reflux.
Area of Science:
- Pediatric Urology
- Congenital Abnormalities
- Surgical Management
Background:
- Congenital anterior urethral diverticulum (CAUD) is a rare pediatric condition.
- Typically presents with ventral penile swelling, recurrent urinary tract infections (UTIs), or poor urinary stream.
Purpose of the Study:
- To review the clinical presentation, management, and outcomes of pediatric CAUD.
- To evaluate the efficacy of different surgical approaches and conservative management strategies.
Main Methods:
- Retrospective analysis of nine pediatric patients diagnosed with CAUD.
- Review of clinical data including presentation, surgical interventions, and follow-up evaluations (e.g., urethrograms, renal function).
Main Results:
- Primary surgical excision and repair were successful in most patients, with a low incidence of complications like urethral stricture.
- Conservative management was effective for CAUD associated with obstructive uropathy and vesicourethral reflux (VUR).
- Initial marsupialization followed by definitive surgery proved safe for patients with severe infection (gross pyuria).
Conclusions:
- Primary excision and repair is the recommended treatment for CAUD.
- Conservative management is a viable option for CAUD with obstructive uropathy and VUR.
- Marsupialization followed by delayed definitive surgery is a safe approach for infected CAUD.
Abstract:
Congenital anterior urethral diverticulum (CAUD) is an uncommon condition in children usually presenting as a fluctuant ventral penile swelling. Retrospective data of nine patients with CAUD were analyzed. Patients presented with penile swelling (n = 7), recurrent urinary tract infection (UTI) (n = 5), and poor urinary stream (n = 2). One patient who had gross pyuria was treated with initial marsupialization of the diverticulum and later underwent a definitive surgical procedure. One had deranged renal function, grade IV vesicourethral reflux (VUR), and UTI and was treated with initial urinary diversion followed later by excision of the diverticulum and urethral reconstruction. Of the seven patients who underwent primary repair of the diverticulum, all except one had a normal urethrogram on follow-up. One patient developed a stricture of the urethra that was treated with dilatations and is presently asymptomatic. In the two patients who had bilateral VUR, one grade III and the other grade IV, preoperatively, the reflux subsided and did not require antireflux surgery. Only one patient is on low-dose urinary antibiotic prophylaxis and presently has grade II reflux. Primary excision and repair is the preferred mode of treatment for CAUD. CAUD producing obstructive uropathy and VUR can be managed conservatively. In the presence of gross pyuria, marsupialization of the diverticulum followed by definitive surgery at a later date is safe and recommended.