[Clinical usefulness of the non-invasive functional study of the lower urinary tract voiding phase as a predictor of resolution after the first endoscopic treatment of vesico-ureteral reflux in children older than 3 years.] / Utilidad del estudio funcional no invasivo de la fase de vaciado del tracto urinario inferior como factor predictor de la resolución tras el primer tratamiento endoscópico del reflujo vesico-ureteral en niños mayores de 3 años.

OBJECTIVES: To determine the usefulnessof voiding diary (VD), uroflowmetry with electromyography(UF-EMG), bladder wall thickness (before micturition)(VWTUS) and residual urine (PVR) (ultrasound measure)in predicting the outcome of the first endoscopic treatment(1ENDT) of vesicoureteral reflux (VUR) in children> 3 years. METHODS: Cross-sectional ambispective study of 48children with vesicoureteral reflux. Those with previousendoscopic treatment, age or neurological abnormalities and a history of urethralor abdominal surgery were excluded. The outcomevariable was the correctness (by isotopic cystography)three months after 1ENDT. Univariate and multivariateanalyses were performed through a Multilayer Perceptronnetwork and a logistic regression model EmpiricalBayesian penalized type LASSO Elastic net. Diagnosticaccuracy were determined. RESULTS: Mean age of the sample was 6.8 +/- 2.28years. The rate of VUR correction after 1ENDT was 77%.The variables selected by both methods were: VD-retentionist(OR 3.90), high PVR (OR 2.69), high VWTUS (OR4.44). Normal UF-EMG was a preventive variable (OR0.38). Diagnostic accuracy (pSp=48.7%), UF+EMG (Se=27.3%(Se=72.7% (AUC=0.8 cut point 20 ml),VWTUS (Se=81.8% (AUC=0.8 cut point4.6 mm). There were no statistical differences betweenPVR and VWTUS. Combined use of UF+EMG+PVR(Se=90.9%in predicting the persistence of VUR after 1ENDT inchildren > 3 years. After screening with a VD, UF-EMG+ RPM combination could be useful to detect these patientsand propose a treatment that improves bladdervoiding function prior to surgery.

OBJETIVOS: Determinar la utilidad deldiario miccional (DIM), la flujometría asociada a laelectromiografía (UF-EMG) y los parámetros ecográficoscomo son el espesor de la pared vesical premiciconal(EPVECO) y el residuo postmiccional (RPM) en la prediccióndel resultado del primer tratamiento endoscópico(1TEND) del Reflujo Vesico-Ureteral (RVU) en niños > 3años.MATERIAL Y MÉTODOS: Estudio transversal ambispectivode 48 niños con RVU. Criterios de exclusión: 1TENDprevio, edad y cirugía uretral o abdominal previas. Variableresultado: corrección del RVU (cistografía isotópica realizadatres meses después del 1TEND). Se realizaronanálisis univariante y multivariante mediante una red perceptrón multicapa y un modelo de regresión logísticapenalizada tipo Empirical Bayesian LASSO Elastic net.Se consideraron significativas las variables elegidas porambos métodos estadísticos. Se estudió el rendimientodiagnóstico de las pruebas individuales y combinadas. RESULTADOS: Media de edad: 6,8 +/- 2,28 años.Tasa de corrección del RVU traspredictoras de la persistencia del RVU tras 1TENDseleccionadas por ambos métodos: DIM-hábito retencionista(OR 3,90), RPM elevado (OR 2,69), EPVECOaumentado (OR 4,44). La UF-EMG sin alteracionesen el trazado se comportó como variable preventiva(OR 0,38). Rendimiento diagnóstico (p(Se=98% (Se=27,3%RPM (Se=72,7% (AUC=0,8 punto decorte óptimo 20 ml), EPVECO (Se=81,8%(AUC=0,8 punto de corte óptimo 4,6 mm).No existierondiferencias entre el uso del RPM y el EPVECO(p>0,05). Uso conjunto de UF-EMG+RPM (Se=90,9%Es=92%) (pCONCLUSIONES: El estudio funcional no invasivo dela fase de vaciado es útil en la predicción de la persistenciade RVU tras el 1TEND en niños >3 años. Trasel cribado con un diario miccional, la UF-EMG+RPMpodrían ser útiles para detectar a estos pacientes y plantearun tratamiento que mejore el vaciado vesical previoa la cirugía.

[Endoscopic treatment of vesicoureteral reflux in pediatric patients with the diagnosis of neurogenic bladder. Results and long-term outcome]. / Tratamiento endoscópico del reflujo vésicoureteral en pacientes pediátricos diagnosticados de vejiga neurógena. Resultados y evolución a largo plazo.

OBJECTIVES: To know the results, complications and outcomes of eight patients with the diagnosis of neurogenic bladder (NB) who underwent vesicoureteral reflux surgery by subureteral injection of inert substances, trying to precise its indication in the therapeutic scheme for neurogenic bladder dysfunction. METHODS: Retrospective review of the results and complications recorded during follow-up in eight pediatric patients with NB secondary to various pathologies and the diagnosis of VUR treated by subureteral injection of Teflon paste (1 case), polydimethylsiloxane (6) and dextranomer/hyaluronic acid copolymer (1). RESULTS: In 8 (72.7%) of the 11 ureters treated VUR was cured after first injection. VUR stopped after second endoscopic treatment in 2 of the 3 ureters with persistent VUR. The efficacy of endoscopic treatment after second injection achieved 90.9%. In 2 unilateral cases we observed contralateral VUR, which cured in one case after endoscopic treatment and the other one followed a conservative scheme. Over the follow-up period (Mean FU time 51.8 +/- 28.5 months) 4 cases presented complications. VUR recurred in two: in one contralateral VUR was detected 19 months after first treatment, the other one presented bilateral ureterohydronephrosis with recurrent urinary tract infections and required augmentation cystoplasty. CONCLUSIONS: Endoscopic treatment is an effective option when choosing surgical treatment for VUR in a patient with neurogenic bladder. It is necessary to follow the long-term outcome of patients after surgery, mainly those with abnormal bladder capacity and compliance and active or dyssynergic urethra due to the possibility of recurrence of the VUR.

[Epididymal cysts in childhood]. / Quistes epididimarios en la infancia.

OBJECTIVES: To retrospectively review all cases of epididymal cysts registered over the last five years; 15 cases have been included. Simple epididymal cysts are a rare pathology in childhood, being most of them diagnosed in puberty. Currently, due to the scarce case series, there is not consensus about the most adequate therapy. METHODS/RESULTS: Mean age at presentation was 11.5 yr. (1-16). 50% were diagnosed incidentally and 29% presented increased scrotal size. 46% of the cases had associated left varicocele (n = 6) and 26% had history of orchiepididymitis. Diagnosis was based on physical examination and confirmed by ultrasound. 40% of the patients underwent surgery and the remainder received conservative treatment without evidence of complications on follow-up. CONCLUSIONS: Due to the benign character and good evolution of all cases of epididymal cysts treated conservatively and the absence of benefit after surgical treatment, we believe that management should be conservative with clinical and ultrasound controls, leaving surgery for cysts with complications. The frequent association between epididymal cysts and varicocele is related to coincidence of both pathologies in the prepuberal age.

[Encrusted pyelitis in a transplanted kidney]. / Pielitis incrustante en riñón trasplantado.

OBJECTIVES: To emphasize the importance of early diagnosis of encrusted pyelitis in kidney transplant patients. METHODS: We report one case of encrusted pyelitis in a 10-year-old girl with a kidney graft who was treated by means of nephrostomy tube irrigation with an acidifier liquid substance. RESULTS: After 16 days of treatment there was a significant decrease of the size of the calcified pyelic plaque, keeping a good renal function afterwards. CONCLUSIONS: This disease should be thought of in every case of kidney transplant patient with negative urine cultures and alkaline pH, and the microbiologist should be alerted of the possibility of urinary tract infection by Corynebacterium.

[Urachal diverticuli. Diagnosis and treatment]. / Divertículos de uraco. Diagnóstico y tratamiento.

OBJECTIVE: To determine the utility of different diagnostic imaging techniques in diverticulum of the urachus and discuss the approach in the incidentally discovered cases such as those detected due to infectious complications. METHODS/RESULTS: We reviewed the literature, with special reference to the diagnostic and therapeutic aspects of diverticula of the urachus. A case that presented with urinary infection and omphalitis, with the characteristic radiological findings, that resolved after surgical treatment and previous antibiotic therapy, is also described. CONCLUSIONS: Ultrasound is useful in the initial evaluation of patients with signs of periumbilical inflammation. If a urachal diverticulum is diagnosed, retrograde cystourethrography should be performed to rule out associated genitourinary pathology or lower urinary tract obstruction. In cases discovered incidentally, we underscore the importance of elective surgery to excise the diverticulum since it could progress to malignancy. In cases with infectious complications, bladder catheterization and antibiotic treatment before performing subsequent elective surgery offer advantages over primary excision. For young patients, we advocate performing the Pfannenstiel incision. This approach offers excellent visualization and exposure of the entire urachus with a minimum surgical scar.