Objective To summarize the management of testicular tumors in children. Methods The clinical data of 55 children (age between 2 months to 12 years) with testicular tumors were retrospectively analyzed.Most of the children presented with painless scrotal mass.Of them 25 cases had yolk sac tumors,24 had teratomas,2 lymphomas,1 seminoma,2 dermoid cysts and 1 lymphangioma. Results Of the 55 cases 31(56%) were followed up with a mean time of 3 years.Among the 25 (68%) cases with yolk sac tumors 17 were followed up,of whom,9 were with stage Ⅰ and they underwent high amputation of spermatic cord with orchiectomy;one with stage Ⅳ and 3 with relaps of tumors who underwent chemotherapy and surgery were alive and well.Of the 14 cases with teratomas who were followed up,5 underwent enucleation of teratomas with retention of testiculi;and one with malignant teratoma underwent surgery.All of them are alive and free of tumor recurrence. Conclusions Children with testicular yolk sac tumors in stage I can be managed by orchiectomy alone,while those in stage Ⅱ-Ⅳ can be treated with a combination regimen of surgery and chemotherapy (PVB).Testicular-sparing enucleation surgery can be used in some benign testicular tumors.

Objective To investigate the experience of diagnosis and management of coexisting ureteropelvic junction obstruction (UPJO) and nonreflux megaureter (NRM).Methods The retrospective study of UPJO with NRM was based on 10 years information retrieved from January 2005 to December 2015.The data of 13 patients (8 males and 5 females) were available and recorded.Mean age at surgery was 3.7 years old (range 1.8 to 14 years).The diagnosis and mangement were summarized.Coexisting ureterovesical junction obstruction (UVJO) and vesicoureteral reflux,iatrogenic stricture and vesicoureteral reflux were excluded.Intravenous pyelography,voiding cystourethrography,ultrasound and CT reconstruction were performed before operation.Only six patients had an accurate diagnosis as UPJO with UVJO before surgery.Pyeloplasty was the initial surgical management choice for 10 patients,and ureteroneocystostomy in 3 patients.Results UVJO were diagnosed with pyelography techniques in 3 patients after pyeloplasty,while 4 were diagnosed as nonreflux and nonobstruction megaureter.Of the 10 patients who underwent initial pyeloplasty,additional ureteroneocystostomy was required in 3 and the prognosis was good.Additional pyeloplasty was required in 2 of the 3 patients who initially underwent ureteroneoeystostomy.Mean follow-up time from last operation was 23.3 months (6-53 months),the overall prognosis was good.Conclusions It is often difficult to correctly diagnose coexisting UPJO and NRM.In patients with UPJO,it is highly recommended nephrostomy radiography after pyeloplasty to evaluate the distal ureterovesical junction.Initial pyeloplasty is always recommended as first-line therapy.Additional ureteroneocystostomy was required when hydroureteropelvic was aggravated.

Surgical treatment of pelvic fracture-associated urethral injury(PFUI) continues to be a difficult problem to be solved in urology.Children with an immature prostate and puboprostatic ligament may suffer from posterior urethral disruptions in a manner different from adults.Considering these distinctions,the management of pediatric PFUI presents a challenge for urologist as no consensus or algorithm has been proposed or accepted.Now,through analyzing the pathogenesis,presentation,diagnosis and treatment of PFUI,give the principle of the management.The choice of immediate repair or delayed repair should be decided according to the particular situation.Immediate Ⅰ stage anastomosis of urethra for PFUI is recommended when the patient's condition is stable,serious complications are treated,and the surgeon is experienced.If the patient's condition is unstable or no experienced urologist is available,a suprapubic catheter should be placed for bladder decompression and try to get a good condition for delayed urethroplasty.

Objective To evaluate the utility of susceptibility weighted imaging (SWI)in the evaluation of traumatic brain injury (TBI)severities.Methods 20 mild TBI patients,20 moderate TBI patients and 20 severe TBI patients were collected.The involving brain regions,numbers and areas of hemorrhagic lesions detected by SWI were analyzed and the differences of each group were com-pared.The correlation analysis between Glasgow coma scale(GCS)scores and each above parameters were underwent.Results The differences of involving regions’number,lesions’number,lesions’area were statistically significant(P <0.05 ).Severe TBI group got the maximum number of involving regions,lesions,and the largest areas,followed by moderate group and mild group.The GCS were highly negatively correlated with the number of involving regions,number of lesions,areas of lesions detected by SWI.In descending order of relevance:GCS with areas detected by SWI(r=-0.982,P=0.000),the number of lesions detected by SWI(r=-0.941,P=0.000),the number of involving regions detected by SWI(r=-0.900,P=0.000).Conclusion The clinical applications of SWI in diagnosing TBI and evalua-ting the TBI severity is of great significance.

Objective To discuss the clinical and pathological features of malignant rhabdoid tumor of the ureter (MRTU).Methods One case of MRTU was reported, a six-year-old girl was admitted to our hospital on May 29, 2014, and presented left loin pain 2 weeks, ultrasound showed gradually progressing hydronephrosis and hydroureter.During a physical examination, she felt tenderness in the left kidney area and no mass was palpable in abdomen.The ultrasound showed left sided gross hydroureteronephrosis and a round hyperechogenic mass in the inferior pole of the left ureter (In front of the left iliac vessel), with no obvious borders.Contrast-enhanced CT suggested a gross dilatation of the left kidney and ureter with a solidappearing lesion in the lower ureter;neither additional abdominal abnormalities nor enlarged lymph nodes were seen in both examinations.The surgery began with incision of left lower abdomen.The partial ureter of neoplasm was excised along with invaded psoas and posterior peritoneum by gross inspection, then ureteroureterostomy was performed.The severed ureter was completely blocked with the ill-defined neoplasm and was 3.3 cm in length and 2.1 cm in width.Results The ureteral neoplasm was excised,along with the invaded psoas and posterior peritoneum,after that ureteroureterostomy was performed.HE showed the diffuse large round nuclei, vesicular chromatin, prominent nucleoli cells, and moderate amounts of eccentrically placed eosinophilic cytoplasm.Immunohistochemical studies were positive for cytokeratin, epithelial membrance antigen and vimentin, negative for INI1, METU hereby was confirmed.She underwent a chemotherapy regimen consisting of ICE, alternating with VDC.Four courses chemotherapy (3 months) later,CT scan suggested hematogenous metastasis of lung.The family refused further treatment and the patient died of systemic metastasis eight months after surgery.Conclusion MRTU was a rare and highly aggressive tumor with a poor prognosis.

Objective To evaluate the application of preserved urethral plate urethroplasty to treat urethral fistula after hypospadias repair. Methods Two hundred and twenty-four cases with u-rethral fistula after hypospadias repair were treated by preserved urethral plate urethroplasty from 2001 to 2006.Follow-up data were reviewed and analyzed.All of these cases had big(>1 cm)ure-thral fistula.One hundred and two failed hypospadias cases were repaired by tubularized incised plateurethroplasty(Snodgrass).The patients were 2-16 years old and mean age was 3.7 years old.In thesame time period,86 failed hypospadias cases were repaired by Duplay urethroplasty.The children were 2-14 years old and mean age was 3.5 years old.Twenty failed hypospadias cases were repaircd by Onlay island flap urethroplasty and another 1 6 failed hypospadias cases were repaired by Flip-Flap urethroplasty. Results Fistulas were successfully repaired in 86(84.3%)cases out of 102 tubular-ized incised plate urethroplasty procedure.There were 1 3 urethral fistulas and 3 urethral strictures.Seventy-five(87.2%)cases were successful out of 86 Duplay procedure.There were 9 urethral fistulas and 2 urethral strictures.There was no significant difference between these tWO groups of results(P>0.05).Nineteen cases were successful out of 20 Onlay urethroplasty procedures and there was only l urethral fistula.Fourteen cases were successful out of 1 6 Flip-Flap procedures and there was onlv 2 u-rethral fistulas. Conclusions Surgical procedure for urethral fistula repair should be chosen accord-ing to the condition of penis.Tubularized incised plate urethroplasty can get same satisfactory result comparing with Duplay method for failed hypospadias repair.More Snodgrass should be used to assure the cosmetic penis.

Objective To discuss the management of urethral duplication in children. Methods The clinical data of 1 8 children(all are males)with urethral duplication were retrospectivelv ana-lyzed. All the 18 patients were sagittal plane included epispadias in 6,hyposPadias in 4 and Y type in the remaining 8. In 6 cases with epispadias,3 patients underwent excision of the accessorv dorsal ure-thra,3 patients without operation.Urethroplasty was necessary in the patient with a duplicated hypo-spadiac urethra. Of 8 patients with Y-type urethral duplication,7 patients underwent 2 stage repair including displacement of the urethra from the anal canal to the perineum at stage 1 and subsequent urethral reconstruction at stage 2.The ventral urethra which was hypospadias had been excised in the other one. Results All the patients were followed-up. Good cosmetic and functional resuIts were a-chieved in the 3 boys who underwent excision of the accessory dorsal urethra.In the hypospadiac du-plication,2 patients could void spontaneously through a normally positioned granular meatus.One boy presented with urethral stenosis after operated. One boy had a vesicostomy for neuropathic bladder. In Y-type urethral duplications,only 1 patient was successful after 2-stage urethroplasty,3 patients de- veloped urethra stricture or fistula,3 boys need the 2-stage operation,the other 0ne who underwent excision of the ventral urethra could void spontaneously. Conclusions Urethral duplication is a rare congenital anomaly.The clinical presentation varies because of the different anatomical Datterns of this abnormality. Commonly the ventral urethra is most functional and maintained after surgical correc-tion.Surgical management should be individual and depend on the anatomical configuration of the du-plicated urethras.

Objective To summarize the management of immature testicular teratomas in children.Methods The clinical data of 19 children (age between 16 days to 13 months) with immature testicular teratomas were retrospectively analyzed.There were 10 cases in left and 9 cases in right side.The main presentation was painless scrotal mass.The size of the tumor was 1.5 cm × 1.2 cm × 0.5 cm-6.0 cm × 5.0 cm × 4.5 cm.Abnormal alpha fetopmtein (AFP)concentrations were detected in 17 patients before surgery.Results Testis-sparing surgeries were done in 11 patients,and the other 8 patients underwent testicle resection because of tumor severely invading testis.Fifteen cases were followed up for 1-10 years.All of them were alive.Conclusions Immature testicular teratomas was rare and almost presenting in children younger than 1 year old.The biological behavior of immature testicular teratomas in children was benign.Testicular-sparing surgery was possible.Close follow-up should be done postoperatively.

Objective To discuss the unique biological,histological and clinical features of pediatric renal cell carcinoma (RCC).Methods A retrospective review and biological analysis of all RCC cases presenting to our hospital from January 1973 to March 2012 was undertaken.Results Twenty-nine RCC pediatric patients (16 boys,13 girls) with mean age of 9.6 (range 2.5-16.0) years were identified.The presentations included hematuria in 17 (58.6％) cases with 3 who developed hematuria after trauma,abdominal mass with hematuria in 3 (10.3％),abdominal mass in 3,abdominal pain in 2,abdominal pain with hematuria in 1,and incidentally finding in 3.The diameter of tumor was from 2.5 cm to 25.0 cm,mean 6.8 cm.According to TNM stage grouping system,16 cases were stage Ⅰ,10 stage Ⅲ,and 3 stage Ⅳ.Xp1 1.2 translocation RCC was identified in 21 patients,clear cell RCC 6,papillary RCC 2.Of the 29 cases,3 patients with the tumor less than 7-cm had nephron-sparing surgery.A 15-cm tumor was incompletely removed in 1 patient and another patient with a 25 cm× 18 cm×15 cm tumor had gross residual.Nephrectomy was performed for the affected kidney in the remaining 24 patients.Twenty-one patients (Xp1 1.2 translocation RCC 13 patients,clear cell RCC 6,papillary RCC only 2) were followed up from 1.5 to 34.0 years,18 were living well (T1N0M0 in 11 cases,T1N1M0 in 2,T2N1M0 in 3,T3N1M0 in 1 and T4N1M1 in 1) and 3 died of recurrence.Conclusions Although RCC is rare in children,pediatric RCC behaves in a distinct fashion compared with adult forms of RCC.Hematuria is the main symptom in pediatric RCC.Xp11.2 translocation RCC is the predominant form,associated with an advanced stage at diagnosis.Nephrectomy is the common treatment for RCC and nephron sparing surgery could be a reasonable option for patients with tumor smaller than 7 cm.For localized RCC (T1-2 N0-1 M0),simple kidney removal surgery is sufficient for treatment without lymph node dissection and postoperative adjuvant treatment.

Objective To summarize the experience about the diagnosis and treatment of bladder benign neoplasm in children.Methods A retrospective study was conducted for a total of 15 patients with bladder benign neoplasm from October 2006 to May 2016.There were 10 males and 5 females with a mean age of 8.7 years (ranging 1.1-13.8 years).The clinical manifestations of 15 patients included hematuria in 9 patients,frequent micturition with urgent and painful in 3 patients,dysuria in 1 patient,abdominal pain in 2 patients and headache during voiding in 1 patient.Ultrasound showed solid masses in the bladder with iso-echoic or nonhomogeneously hypoechoic.CT scanning showed regular or irregular mass with some enhancement in the bladder.All cases received tumor complete resection by opening operation and bladders were preserved.Among the 15 cases,neoplasms located in the anterior,posterior and lateral wall of bladder in 9 cases,ureteral orifice in 4 cases and trigone of bladder in 2 cases.The size of tumors ranged from 1.2 to 6.0 cm (mean 3.1 cm).The tumors were unifocal and seemed like papillary or cauliflower.The literatures of benign neoplasm of bladder were reviewed,which focused on the clinic characters,pathological classification and therapeutic method.Results Pathologic type included papilloma in 5 patients,inverted papilloma in 1 patient,inflammatory myofibroblastic tumor in 7 patients,hemangioma in 1 patient,pheochromocytoma in 1 patient.Fifteen patients were followed up for 6 to 36 months,mean 26.7 months.All patients recovered well without relapse or metastasis Conclusions Bladder benign neoplasm in children is rare with many kinds of pathological classification.The major clinical manifestation is gross hematuria while dysuria is unusual.Tumors are fewer in trigone of bladder.The best treatment is to resect the tumor completely with bladder preservation if possible.