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Журнал "Хирургия детского возраста" 1-2 (50-51) 2016

A Rare Case of Urethral Caruncle Complicated with Neuromuscular Bladder Dysfunction in a 9-Year-Old Girl

Авторы: Shevchuk D.V. - Zhytomyr Regional Children’s Clinical Hospital, Zhytomyr, Ukraine; P.L. Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine; Zhytomyr State University named after I. Franko, Zhytomyr, Ukraine

Рубрики: Педиатрия/Неонатология, Хирургия

Разделы: Справочник специалиста

Карункул уретри — захворювання дистальної уретри, що виникає в основному в жінок у постменопаузальному періоді. Розташований на задній стінці меатуса. У доступній літературі описано кілька випадків уретрального карункула в дівчаток. Єдиним методом лікування карункула є хірургічна операція, що полягає в його висіченнi. Представлено клінічний випадок лікування уретрального карункула, ускладненого нервово-м’язовою дисфункцією сечового міхура, у дівчинки 9 років. Таким чином, уретральний карункул у дівчаток є досить рідкісним захворюванням. Може викликати інфравезикальну обструкцію, що призводить до нервово-м’язової дисфункції сечового міхура. Хірургічне видалення уретрального карункула ліквідовує інфравезікальну обструкцію та покращує евакуаторну функцію сечового міхура.

Карункул уретры — заболевание дистальной уретры, возникающее в основном у женщин в постменопаузальном периоде. Расположен на задней стенке меатуса. В доступной литературе описано несколько случаев уретрального карункула у девочек. Единственным методом лечения карункулы является хирургическая операция, заключающаяся в его иссечении. Представлен клинический случай лечения уретрального карункула, осложненного нервно-мышечной дисфункцией мочевого пузыря, у девочки 9 лет. Таким образом, уретральный карункул у девочек является довольно редким заболеванием. Может вызвать инфравезикальную обструкцию, что приводит к нервно-мышечной дисфункции мочевого пузыря. Хирургическое удаление уретрального карункула ликвидирует инфравезикальную обструкцию и улучшает эвакуаторную функцию мочевого пузыря.

Urethral caruncle — a disease of the distal urethra, which occurs mainly in postmenopausal women. It is located on the back meatal wall. The available literature describes few cases of urethral caruncle in girls. The only treatment for caruncle is surgery, which consists of its excision. The following is a clinical case of treatment of urethral caruncle complicated with neuromuscular dysfunction of the bladder in a 9-year-old girl. Thus, urethral caruncle in girls is a fairly rare disease. It may cause an obstruction below the bladder, leading to neuromuscular dysfunction of the bladder. Surgical removal for urethral caruncle eliminates the formation of obstruction below the bladder and improves evacuation function of the bladder.

Ключевые слова

уретральний карункул, дівчинка, нервово-м’язова дисфункція сечового міхура.

уретральный карункул, девочка, нервно-мышечная дисфункция мочевого пузыря.

urethral caruncle, girl, neuromuscular dysfunction of the bladder.

The article was published on p. 97-99

Urethral caruncle — a disease of the distal urethra, which occurs mainly in postmenopausal women. The cause is unknown. It’s located on the back meatal wall.

Differential diagnosis should be made with urethral prolapse. Clinically caruncle is easily distinguished from urethral prolapse — while caruncle purple mass located on one side of the urethra, the prolapse — around the opening of the urethra [1].

The available literature describes few cases of urethral caruncle in girls. The results presents in Table 1.

The only treatment for caruncle is surgery, which consists of its excision (Fig. 1).

The following is clinical case of the treatment for urethral caruncle complicated with neuromuscular dysfunction of the bladder in a 9-year-old girl.

The child C., 9 years old (case № 8086), was on in-patient treatment in a surgical department № 2 of Zhytomyr Regional Children’s Hospital from July 3 to July 13, 2015. She was hospitalized with complaints of violation of voiding, bloody availability discharge from the genital tract. From history we know that these complaints appeared on June 29, 2015. A self-addressed to hospital. On examination of the genitals, in the area of urethra was visualized purple formation to 0.8 cm in diameter with areas of necrosis in the center (Fig. 2).

Test results: complete blood count, hemoglobin 118 g/L, erythrocyte 3.69 • 1012/L, leukocytes 9.0 • 109/L, erythrocyte sedimentation rate of 5 mm/h. Urine: specific gravity 1014, leukocytes 3–4 in the field of view, epithelium flat 1–2, fresh erythrocytes 2–3 in the field of view. Ultrasound for kidney: moderate swelling of the parenchyma of both kidneys, bilateral pyelectasis , right nephroptosis (left kidney 80 × 34 mm, pelvis 11 × 8 mm; right kidney 84 × 37 mm, pelvis 11 × 7 mm). Ultrasound for pelvic pathology — wasn’t found. July 5 2015, 11:10–11:20 — fulfilled diagnostic cystoscopy (after treatment vulva antibacterial soap with technical difficulties (urethral lumen formation covers ~ 3/4 of 12 hours of standard dial) made 13 Fr installation cystoscope — a significant amount of residual urine. Instillation fluid 200.0 ml. Revision of the bladder. Eyelets type «golf hole» slimy pink. The wall of the bladder is trabecular. Bladder neck and proximal urethra are normal. Cystoscope and fluid deleted; July 5 2015, 11:20–11:35 — performed surgery — removal of the tumor (after processing operating margins twice held circular excision of tumor (sent for histological examination)). Seam wound PGA Resorba 6/0. In the lumen of the urethra and bladder catheter set Foley 12 Fr). July 9, 2015 catheter removed. Discharged home in satisfactory condition, voiding is not broken. Results histology (№ 8679-80) from July 14, 2015: angiomatosis fibrous polyp of the urethra (caruncle) (Fig. 3).

Thus urethral caruncle in girls is a fairly rare disease. It may cause an obstruction below the bladder, leading to neuromuscular dysfunction of the bladder. Surgical removal for urethral caruncle eliminates the formation of obstruction below the bladder and improves evacuation function of the bladder.

Список литературы

1. Jones H.E., Fisher H.J. Urethral prolapse in girls // Arch. Dis. Child. 1971; 46(245): 107-108.

2. Coleman G.B. Large Urethral Caruncle In A Girl Of Nine Years: A Preliminary Note, With A Summary Of The Subject // JAMA. 1913; 60(17): 1281-1283.

3. Türkeri L., Simşek F., Akdaş A. Urethral caruncle in an unusual location occurring in prepubertal girl // Eur. Urol. 1989; 16(2): 153-154.

4. Kim K.K., Sin D.Y., Park H.W. Urethral caruncle occurring in a young girl — a case report // J. Korean Med. Sci. 1993; 8(2): 160-161.

5. Yakasai I.A., Aji S.A., Muhammed Y.A., Abubakar I.S. Unusual Presentation Of Urethral Caruncle In A 2 Year Old Child: A Case Report // Asian Journal Of Natural & Applied Sciences. 2012; 1(4): 21-26.

6. Chiba M., Toki A., Sugiyama A., Suganuma R., Osawa S., Ishii R., Nakagami T., Suzuki J., Watarai Y., Kawano S., Suzuki K. Urethral caruncle in a 9-year-old girl: a case report and review of the literature // J. Med. Case Rep. 2015; 28 (9): 71.

7. Becker L.E. Urethral caruncle: a herald lesion for distal urethral stenosis? // J. Natl Med. Assoc. 1975; 67(3): 228-230.

Журнал "Хирургия детского возраста" 1-2 (50-51) 2016

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A Rare Case of Urethral Caruncle Complicated with Neuromuscular Bladder Dysfunction in a 9-Year-Old Girl

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