Congenital By Thomas
A. Rozanski, Tacoma,
Prepubic Sinus
Victor J. Kiesling, Jr, and Edward S. Tank
Washington
and Portland,
Oregon
0 We report the fourth case of a congenital prepubic sinus extending from the anterior bladder wall through rectus fascia to overlying skin. Intermittent erythema and discharge prompted exploration and excision. This lesion may represent a mild forme fruste of the midline closure defects. 0 1990 by W.B. Saunders Company. INDEX WORDS:
Prepubic sinus.
Fig 2.
C
AMPBELL et al’ reported three cases of congenital prepubic sinus tracts, two female and one male patients. They suggest that the lesion may represent a variant of normal embryologic development. We recently encountered a similar case in a female infant. CASE
REPORT
A lo-month-old
white girl was evaluated for a congenital sinus just above the pubic bone that intermittently became irritated, inflamed, and drained fluid. She had no history of urinary tract infection, umbilical drainage, or associated suprapubic swelling. Ultrasound examination showed normal kidneys and a normal abdominal wall. A retrograde cystogram was normal. Because of persistent drainage, the lesion was surgically explored. A probe could be advanced 2 cm down the sinus tract (Fig 1). Dissection was carried beyond the extent of the probe when an obvious obliterated tract was easily followed through midline rectus fascia just above the pubic bone. The tract was 5 cm long and ended blindly at the anterior bladder wall (Fig 2). Histological examination of the specimen showed a squamous epithelium-lined sinus tract. Convalescence was uneventful and the child remains asymptomatic.
Intact, excised prepubic sinus tract.
DISCUSSION
The congenital prepubic sinus is a tract originating in skin overlying the symphysis pubis and extending to but not communicating with the anterior bladder wall. Campbell et al’ reported three such cases. Histological study of the specimens showed proximal transitionallike epithelium and distal squamous epithelium. One of the patients had marked diastasis of the pubic symphysis and they proposed that the etiology of this lesion was a forme fruste of extrophy/epispadias or a dorsal urethral duplication. Whatever the etiology, patients with a congenital prepubic sinus may come to the attention of urologists or pediatric surgeons because of an obvious midline suprapubic dimple or because of inflamatory changes with drainage from the sinus. Local excision is curative, and advocated for symptomatic lesions. REFERENCE
1. Campbell J, Beasley S, McMullin N, et al: Congenital prepubit sinus: Possible variant of dorsal urethral duplication (Stephens type 2). J Urol 137:505-507, 1987
Fig 1. tract.
Probe
identifying
midline
location
of prepubic
sinus
Journal of Pediatric Surgery, Vol 25, No 12 (December), 1990: p 1301
From the Department of Surgery (Urology Service), Madigan Army Medical Center, Tacoma, WA, and The Oregon Health Sciences University, Portland, OR. The opinions or assertions contained herein are the private views of the authors and are not to be construed as oficial or as rejecting the views of the Department of the Army or of the Department of Defense. Address reprint requests to Edward S. Tank, MD, Division of Urology, Oregon Health Sciences University. 3181 SW Sam Jackson, Portland, OR 97201. 6 1990 by W.B. Saunders Company. 0022-3468/90/2512-0035$03.00/O
1301
A. Rozanski, Tacoma,
Prepubic Sinus
Victor J. Kiesling, Jr, and Edward S. Tank
Washington
and Portland,
Oregon
0 We report the fourth case of a congenital prepubic sinus extending from the anterior bladder wall through rectus fascia to overlying skin. Intermittent erythema and discharge prompted exploration and excision. This lesion may represent a mild forme fruste of the midline closure defects. 0 1990 by W.B. Saunders Company. INDEX WORDS:
Prepubic sinus.
Fig 2.
C
AMPBELL et al’ reported three cases of congenital prepubic sinus tracts, two female and one male patients. They suggest that the lesion may represent a variant of normal embryologic development. We recently encountered a similar case in a female infant. CASE
REPORT
A lo-month-old
white girl was evaluated for a congenital sinus just above the pubic bone that intermittently became irritated, inflamed, and drained fluid. She had no history of urinary tract infection, umbilical drainage, or associated suprapubic swelling. Ultrasound examination showed normal kidneys and a normal abdominal wall. A retrograde cystogram was normal. Because of persistent drainage, the lesion was surgically explored. A probe could be advanced 2 cm down the sinus tract (Fig 1). Dissection was carried beyond the extent of the probe when an obvious obliterated tract was easily followed through midline rectus fascia just above the pubic bone. The tract was 5 cm long and ended blindly at the anterior bladder wall (Fig 2). Histological examination of the specimen showed a squamous epithelium-lined sinus tract. Convalescence was uneventful and the child remains asymptomatic.
Intact, excised prepubic sinus tract.
DISCUSSION
The congenital prepubic sinus is a tract originating in skin overlying the symphysis pubis and extending to but not communicating with the anterior bladder wall. Campbell et al’ reported three such cases. Histological study of the specimens showed proximal transitionallike epithelium and distal squamous epithelium. One of the patients had marked diastasis of the pubic symphysis and they proposed that the etiology of this lesion was a forme fruste of extrophy/epispadias or a dorsal urethral duplication. Whatever the etiology, patients with a congenital prepubic sinus may come to the attention of urologists or pediatric surgeons because of an obvious midline suprapubic dimple or because of inflamatory changes with drainage from the sinus. Local excision is curative, and advocated for symptomatic lesions. REFERENCE
1. Campbell J, Beasley S, McMullin N, et al: Congenital prepubit sinus: Possible variant of dorsal urethral duplication (Stephens type 2). J Urol 137:505-507, 1987
Fig 1. tract.
Probe
identifying
midline
location
of prepubic
sinus
Journal of Pediatric Surgery, Vol 25, No 12 (December), 1990: p 1301
From the Department of Surgery (Urology Service), Madigan Army Medical Center, Tacoma, WA, and The Oregon Health Sciences University, Portland, OR. The opinions or assertions contained herein are the private views of the authors and are not to be construed as oficial or as rejecting the views of the Department of the Army or of the Department of Defense. Address reprint requests to Edward S. Tank, MD, Division of Urology, Oregon Health Sciences University. 3181 SW Sam Jackson, Portland, OR 97201. 6 1990 by W.B. Saunders Company. 0022-3468/90/2512-0035$03.00/O
1301
