Endoscopic treatment of vesicovasal and vesicoureteral reflux in infants with persisting mesonephric duct.
OBJECTIVE
We present a minimally invasive endoscopic approach for the treatment of persisting mesonephric duct in male infants.


METHODS
Five male infants 2 to 8 months old were referred with a history of recurrent sepsis, epididymo-orchitis and anorectal malformation that was treated elsewhere with initial colostomy. All infants had edematous unilateral testes, fever and poor feeding. Urine and blood cultures yielded the same microorganisms. All infections occurred while the infants were on regimens of prophylactic antibiotics. Comprehensive urological evaluations confirmed ipsilateral renal agenesis, sacral hypoplasia (3 patients), high anorectal malformation, and vesicovasal and vesicoureteral reflux.


RESULTS
All 5 infants underwent urethrocystoscopy under general anesthesia. The ectopic persisting mesonephric duct entered the bladder neck and proximal prostatic urethra. Injection of 0.4 to 0.7 ml Urocol, used as a bulking agent, was administered submucosally at the opening of the persisting mesonephric duct. In 1 patient the orifice of the anomalous duct was not found during urethrocystoscopy, and ipsilateral vas ligation by titanium clips was performed. The results in the remaining 4 patients were excellent, and no further episodes of epididymitis were observed during a mean followup of 30 months.


CONCLUSIONS
The diagnosis of persisting mesonephric duct should be considered in a male child with anorectal anomalies and recurrent epididymo-orchitis, and can be confirmed by radiological studies and cystoscopy. Endoscopic treatment of this anomaly should be considered first line therapy in these patients. However, surgical intervention is mandatory for children not responding to the procedure.
Kajbafzadeh
Abdol-Mohammad
AM
Department of Urology, Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 36 7th St., Saadat-Abad, Ave. Tehran 19987, Iran. kajbafzd@sina.tums.ac.ir
Payabvash
Seyedmehdi
S
D003558:Cystoscopy; D004337:Drug Carriers / Q000008:administration & dosage; D004338:Drug Combinations; D004724:Endoscopy; D004823:Epididymitis / Q000209:etiology / Q000601:surgery; D005944:Glucosamine / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007267:Injections; D008297:Male; D009920:Orchitis / Q000209:etiology / Q000601:surgery; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011446:Prospective Studies; D012008:Recurrence; D014513:Ureter / Q000002:abnormalities*; D013521:Urologic Surgical Procedures, Male; D014649:Vas Deferens / Q000002:abnormalities*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
D004337:Drug Carriers; D004338:Drug Combinations; D011092:Polyethylene Glycols; D005944:Glucosamine