Tumor markers have become important in the armamentarium of diagnostic and prognostic tools in the field of oncology. With advances in the scientific research they have created a place in the management protocols of various tumors. Alpha-fetoprotein (AFP) is one such tumor marker which is known to be elevated in liver tumors and germ cell tumors, especially those with the yolk sac elements. However, there are only a few reports describing elevated AFP levels in Wilms’ tumor, the second most common primary intra-abdominal malignant tumor in children. We present a case of classic Wilms’ tumor with raised AFP levels which followed the trend of treatment.

Labial adhesion is a common gynecologic problem in childhood. It is probably associated with hypoestrogenic state of the female infant. Labial adhesions are usually diagnosed during regular checkups or when the fusion results in post-void dripping, vaginal irritation, dysuria, urinary tract infection or obstruction. Hence, we recommend physicians to perform genital examination in girls who show symptoms of urinary tract infection. Treatment options include topical estrogen or betmethasone creams, manual separation or adhesiolysis. Follow up of these children is important to ensure complete resolution without residual adhesion or recurrence.

In this report of a 13-year old boy, we describe the first case of splenogonadal fusion (SGF) associated with growth hormone deficiency, delayed skeletal maturation and stunting, and provide a review of the literature on SGF based on a search in major medical indexes using the descriptors “splenogonadal”, “splenogonadal fusion” and “congenital anomalies of the spleen”. Predominant in males (15:1), SGF is a rare congenital anomaly with only around 200 cases described involving the presence of splenic tissue in the gonads and, in some cases, a fibrous cord connecting the two structures. SGF may be associated with severe limb anomalies, micrognathism and testicle cancer. Despite frequently increased testicle volume, the condition is usually asymptomatic. Knowledge of SGF is important in the differential diagnosis of malignancies, avoiding unnecessary orchiectomy. Nevertheless, SGF has been observed in association with malignant tumors, especially in patients with cryptorchidism. Key Words:

The present study, conducted on three children with cerebral palsy who had voiding dysfunction. After collecting demographic information, symptoms of voiding dysfunctions were recorded. Then; we did an ultrasonographic evaluation of the bladder to measure residual urine volume. Physiotherapy treatment through percutaneous electrical stimulation of the posterior tibial nerve was performed in 12 sessions. Bladder ultrasonography was repeated after treatment. Abnormal residual urine volume became normal in patients with urinary retention. Percutaneous posterior tibial nerve stimulation reduces symptoms of voiding dysfunctions in children with cerebral palsy.

We report our series of selected patients with complete incontinence in whom the appendix was divided and utilized for creating two continent catheterizable stomas. All patients were treated for urinary and fecal incontinence by split appendix technique. The appendix was divided into two different parts preserving adequate perfusion and used for creating an appendicocecostomy (ACE) and an appendicovesicostomy at the same time. After a clinical and radiological follow up, our patients referred a good acceptance and an easily management of the stomas in order to stay dry for all day from urine and feces with improving of their quality of life. The combination of ACE and Mitrofanoff principle have revolutionized the management of urinary and fecal incontinence in patients who are unable to utilize their urethra to keep themselves dry.

Calculi occurring around double J (DJ) stents is a rare occurrence. Our case was of a 12-year-old female who was operated for ureteric re-implantation of both moieties in a case of left sided double moiety with Grade IV VUR. Two DJ stents were kept in situ and patient was lost to follow-up. The stents and resultant calculi came into notice when she came with abdominal pain and dysuria. They were removed by pyelolithotomy with suprapubic cystolithotomy.

Aphallia (penile agenesis) is an extremely rare abnormality with the reported incidence of 1 in 30 million births. The cause of this anomaly is associated with no genital tubercle formation or its development impairment. The majority of patients have 46XY Karyotype. The scrotum, testes and testicular function are usually normal. We report the preliminary experience with 3 cases of aphallia in different age groups along with a review of the literature.