based on > 9000 (postnatal) autopsies. However, in clinical practice the clinician is generally faced with making a radiological diagnosis of ‘URA’ in a child or adult, or perhaps in a fetus in which just one kidney has been visualized on ultrasonography (US) during mid-gestation. Using US, URA can be ‘missed’ in the fetus or neonate because the adrenal, which then occupies the renal bed, can be mistaken for a kidney [6]. Using US, Roodhooft et al. [7] reported that URA occurred in ≈ 1 : 500 of the general population, which is more frequent than the autopsy value cited above [5]. There are caveats about using an ‘empty renal bed’ assessed by US to diagnose URA. Renal ectopia (e.g. pelvic and cross-fused) kidneys should be considered and sought by US [8] and, if necessary, by functional scanning with IVU and/or isotope renography (e.g. with 99m Tc-DMSA, concentrated in functioning tubules). Furthermore, all these radiological techniques might fail to detect a very small ( < 2 cm across) contralateral kidney affected by renal ‘aplasia’ (a tiny, dysplastic organ, containing undifferentiated and metaplastic tissues) or atrophy secondary to renal artery stenosis or neonatal renal venous thrombosis [9–11]. Such ‘remnants’, confirmed at laparotomy, have rarely been implicated in causing hypertension [10,12]; MRI might prove a sensitive technique with which to find such rudiments [10].

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1464-410X.2006.06504.x

Unilateral renal agenesis and the congenital solitary functioning kidney: developmental, genetic and clinical perspectives.

Unusual bladder masses in children.

Intramural bladder-wall abscesses are serious but rather rare. In the few reported cases, their aetiology has not been explicitly explained. In our case, we found a traumatic outcome induced by a urethrocystoscopy that had taken place 4 years prior to the diagnosis of abscess. To date, there has not been much published on these bladder-wall abscesses or urinary tract infections from urethrocystoscopies and Burkholderia cepacia bacteria. As a result, their pathogenesis and aetiology have not been fully explained. In this paper we report on the clinical as well as the subjective well-being of a female child who was diagnosed with a massive full-blown intramural bladder-wall abscess that developed 4 years after she had undergone a urethrocystoscopy.

Intramural bladder-wall abscess: a late complication arising after a urethrocystoscopy?

Background A second primary tumors of the urethra (urethral recurrence) after radical cystectomy has been reported to be more infrequent in patients with ileal orthotopic (neobladder) compared to incontinent diversions. Objective To investigate whether an altered immunogenic environment of urethral tissue is induced by urethro-ileal anastomosis. Methods Between 10/2008 and 12/2009 urethral biopsies of 19 patients (9 neobladder patients, 10 control patients without urethra-ileal anastomosis) were evaluated by conventional histopathological examination and immunohistochemistry for T- (CD3/CD5, CD4, CD8) and B-cell markers (CD20/22, CD79a, CD138). After semi-quantitative assessment, relative cell fractions (B vs. T cells) and subclasses (T4-helper vs. T8-killer cells vs. B cell clones, plasma cells) in neobladder vs. control patients were studied. Unpaired t-test was used for statistical analysis. Results Of 19 included patients, 16 were eligible for analysis (7x neobladder, 9x controls). All neobladder patients had undergone cystectomy for UBC. Comparing relative fractions of cells positive for T- and B-cell markers in NB and CO patients, no statistical differences were observed. In 4/7 neobladder patients relative fraction of CD79a positive B-cells was higher than relative fraction of CD3/CD5 positive T-cells (B/T-ratio 1.3). B cells were predominantly CD138 positive plasma cells (5/7 NB patients). Relative B-cell fraction was lower than T-cell fraction in 7/9 control patients (B/T-ratio 0.6). Neither CD 138 positive plasma cells nor CD22 positive B cell clones were predominant. T-helper and CD8 positive T-killer cells were equally distributed in both neobladder (CD4/CD8-ratio: 2.1) and control patients (CD4/CD8-ratio: 1.9). Conclusions Comparing neobadder and control patients the distribution of B- and T-cells was statistically not different. However, a trend towards an increased presence of B-cells in urethral tissues of NB patients that could become relevant in a larger study might be suggestive for an immunological response induced by connecting urethral and ileal tissue.

/pdf/do-orthotopic-ileal-diversions-induce-immunological-changes-yfpj6vcua6.pdf

Do Orthotopic Ileal Diversions Induce Immunological Changes in Retained Urethral Tissue

Spontaneous bladder wall abscess in a child

We report a case of a bladder-wall abscess in a patient with myelodysplasia and a neurogenic bladder. The aetiology of the abscess was obscure, but the patient had recurrent urinary tract infections and was being managed by clean intermittent catheterisation.

Bladder-wall abscess in a girl with neurogenic bladder.

Fanconi's anemia is an autosomal recessive disease, the main feature being pancytopenia secondary to bone-marrow hypoplasia. However, multiple congenital abnormalities may be encountered, urogenital malformations being common. We describe a patient with solitary crossed renal ectopia, vesicoureteric reflux, hypospadias, and unilateral undescended testis with absent vas deferens.

Fanconi's anemia with solitary crossed renal ectopia, vesicoureteric reflux, and genital abnormalities.

Seventy-two ureteroileal anastomoses taken from ileal conduits removed from 62 patients were examined histologically to characterize the range of mucosal and stromal changes at these sites. All 72 demonstrated variable amounts of subepithelial chronic inflammation and fibrosis. Other histological features included: cystic spaces lined by transitional epithelium (N = 29; 40%; average diameter 1.2 mm); cystic spaces lined by mixed intestinal/transitional epithelium (N = 5; 7%; average diameter 0.77 mm); and cystically dilated intestinal glands (N = 21; 29%; average diameter 0.24 mm). The latter were associated with overgrowth by transitional epithelium, which had prevented mucus drainage. Twenty-one (29%) had mucus pools with no epithelial lining (average diameter 1.2 mm), and polypoidal protrusions into the lumen of the anastomosis were found containing mucus pools (N = 4; 6%; average diameter 1.4 mm), transitional-lined cysts (N = 5; 7%; average diameter 2.2 mm), and mixed intestinal/transitional-lined cysts (N = 2; 3%; average diameter 2.5 mm). Focal rupture of dilated intestinal glands with interstitial pooling of mucus was not uncommon, and marked dystrophic calcification was found in 1 case within a large collection of extracellular mucus. This series confirms that inflammation, fibrosis, and glandular overgrowth by transitional epithelium are common occurrences at ureteroileal anastomosis sites. Subsequent gland rupture may result in sizable accumulations of interstitial mucus, and rarely in marked dystrophic calcification.

S. Ahmed

Papers

Bladder-wall abscess in a girl with neurogenic bladder.

Fanconi's anemia with solitary crossed renal ectopia, vesicoureteric reflux, and genital abnormalities.

Further observations on histological changes at the ureteroileal junction in ileal conduits.