ABSTRACT Purpose: To determine if patients with renal cell carcinoma (RCC) with levels III and IV tumor thrombi are receive any reduction in complication rate utilizing veno-venous bypass (VVB) over cardiopulmonary bypass (CPB) for high level (III/IV) inferior vena cava (IVC) tumor thrombectomy and concomitant radical nephrectomy. Materials and Methods: From May 1990 to August 2011, we reviewed 21 patients that had been treated for RCC with radical nephrectomy and concomitant IVC thrombectomy employing either CPB (n =16) or VVB (n=5). We retrospectively reviewed our study population for complication rates and perioperative characteristics. Results: Our results are reported using the validated Dindo-Clavien Classification system comparing the VVB and CPB cohorts. No significant difference was noted in minor complication rate (60.0% versus 68.7%, P=1.0), major complication rate (40.0% versus 31.3%, P=1.0), or overall complication rate (60.0% versus 62.5%, P=1.0) comparing VVB versus CPB. We also demonstrated a trend towards decreased time on bypass (P=0.09) in the VVB cohort. Conclusion: The use of VVB over CPB provides no decrease in minor, major, or overall complication rate. The use of VVB however, can be employed on an individualized basis with final decision on vascular bypass selection left to the discretion of the surgeon based on specifics of the individual case.

OBJECTIVES: Urothelial carcinoma of the bladder occurs rarely in the first 2 decades of life. We report a case of a 12 year-old child that presented with a Ta grade II/III urothelial carcinoma of the bladder. METHODS: We describe its clinical presentation and diagnostic procedures as well as treatment and followup. Finally, we review the literature to analyze the etiology, treatment, and surveillance of urothelial carcinoma in the pediatric population. RESULTS: Since 1950, there are less than 100 cases of urothelial carcinoma reported in patients less than 30 years, and even less in children and adolescents. Most of the small series describe these tumors as being characteristically superficial and low grade (I-II). This child presented with silent macroscopic hematuria and an MRI revealed a solid and papillary mass measuring 2.7 cm. A cystoscopy and resection of the tumor confirmed the diagnosis. A re-resection at two months confirmed no residual tumor in the bladder. CONCLUSIONS: There is no established criteria for the etiology, treatment, and surveillance of urothelial carcinoma in the pediatric population. Children with gross hematuria as the presenting complaint should undergo a complete evaluation to rule out the presence of urothelial carcinoma.

OBJETIVO: El carcinoma urotelial de vejiga ocurre raramente en las primeras 2 décadas de la vida. Presentamos el caso de un niño de 12 años que presentó un carcinoma urotelial Ta grado II/III. MÉTODOS: Describimos la presentación clínica y el proceso de diagnóstico, asi como el tratamiento y seguimiento. Finalmente, revisamos la literatura para analizar la etiología, tratamiento, y seguimiento del carcinoma urotelial en la población pediátrica. RESULTADOS: Desde 1950, existen menos de 100 casos de carcinoma urotelial reportados en pacientes menores de 30 años, y mucho menos en niños y adolecentes. La mayoría de las pequeñas series describen estos tumors como de caracteristicas superficiales y de bajo grado (I-II). Este niño presentó una hematuria asintomática y una resonancia magnética descubrió una masa sólida y papilar que medía 2.7 cm. La cistoscopía y resección del tumor confirmó el diagnóstico. Una segunda resección 2 meses después confirmó que no existía tumor residual. CONCLUSIONES: No existen normas establecidas acerca de la etiología, tratamiento, y seguimiento del carcinoma urotelial en pacientes pediátricos. Niños con hematuria macroscópica como síntoma principal deberían ser sometidos a una evaluación completa para descartar la presencia de un carcinoma urotelial.