A multicenter international case series highlighting the management of pediatric nephrogenic adenoma.
AI interpretation is pending for this paper.
Open original publication →What the AI sees
Not AI summarized yet.
Research significance
Pending deeper interpretation.
Source abstract
INTRODUCTION: Nephrogenic adenoma (NA) is a rare benign epithelial lesion of the urinary tract, found most often affecting the bladder. Pediatric cases are uncommon and usually follow chronic mucosal irritation from infection, surgery, trauma, or calculi. Care must be taken when evaluating NA, as its workup and management have been incompletely described, and its morphology can resemble malignancy. This study aims to help further describe the presentation, management, and outcomes of NA. METHODS: After IRB approval, we conducted a retrospective descriptive study of pediatric patients (<18 years) with histopathologically confirmed NA. Cases were collected internationally through collaboration with members of the Iberoamerican Society of Pediatric Urology (SIUP) and the European Society for Pediatric Urology (ESPU). Patients ≥18 years or with incomplete data were excluded. Demographic, clinical, histologic, treatment, recurrence, and follow-up variables were analyzed descriptively. RESULTS: Sixteen pediatric NA cases were identified across 11 centers in 7 countries. The mean age at diagnosis was 7.6 years (median 6; range 2.5-17), and 9/16 (56%) were female. Management included transurethral resection in 7/16 (44%), open partial cystectomy in 3/16 (19%), transurethral fulguration in 2/16 (13%), intravesical sodium hyaluronate instillations in 2/16 (13%), laparoscopic-to-open cystectomy in 1/16 (6%), and surveillance in 1/16 (6%). The predominant histologic subtype was mixed tubular-papillary 10/16 (63%), and no malignant transformation was observed. Detectable recurrence occurred in 5/16 (31%) of patients after a mean interval of 12.2 months (6-24 months) and was managed with repeat endoscopic or open interventions, including intravesical sodium hyaluronate in selected cases. Mean follow-up was 4.9 years (3 months-10 years), and 10/16 (62.5%) of patients were asymptomatic with no detectable lesions on imaging at the last follow-up. CONCLUSION: Pediatric NA is an uncommon benign urothelial lesion characterized by bladder predominance, frequent multifocality, and a significant tendency to recur. In this international pediatric series, transurethral resection (TUR) was the most frequently used initial treatment and achieved adequate disease control in most cases, although recurrence was observed in nearly one-third of patients. Some patients managed with conservative approaches, including sodium hyaluronate instillations, experienced symptom reduction. Ultrasound was the most common first-line surveillance modality, supplemented by selective cystoscopy. Continued international collaboration is needed to better define optimal management and follow-up strategies for this rare condition.