[Genital-urinary rhabdomyosarcoma in childhood: our experience]. / Rabdomiosarcoma genitourinario en la infancia, nuestra experiencia.

INTRODUCTION: Rhabdomyosarcoma (RSM) becomes the most common tumour of the soft tissues during the paediatric age. It represents among 2-3% of child tumours. The genital-urinary location is the second most common location, only after head and neck. The treatment is usually medical, being the surgery a mere contribution, except for the cases in which the situation is not under control, when very aggressive surgery is necessary. The aim of this study is to analyse the cases of genial-urinary RMS that have been treated in our centre and the role that surgery has in their treatment. MATERIAL AND METHODS: Retrospective study of 20 patient (7 girls and 13 boys) with a median age of 24 months (range from 1 month to 12 years) with RMS in the aurochs-genial tract who have been treated in our hospital from 1990 to 2012. The variables described are demographic, location of the primary tumour, state at diagnosis, received treatment, both medical and surgical, with greater emphasis on the kind of surgery applied and monitoring in terms of survival. RESULTS: The location of the primary tumour was: bladder (6), paratesticular (5), vagina (3) retroperitoneal space (3), lesser pelvis (2) and prostate (1). All of them received medical treatment with chemotherapy and radiotherapy following International Society of Pediatric Oncology protocol after diagnostic biopsy. Surgery, which was always used as help, was: reappraisal of biopsy (1), orchiectomy (5), tumoral resection (8) and radical surgery (cystoprostatectomy or pelvic exenteration) in 6 patients. There were 3 deaths, 2 because of the evolution of the disease and 1 because of postoperative sepsis. The survival rate is 80% with a median follow - up of 14 years. CONCLUSIONS: The RMS is the most common tumour of soft tissues in childhood and the genital-urinary location is the second most common after the parameningeal one. The treatment is multidisciplinary and the surgery has a contributing role when there is no answer to the medical treatment or when there is a residual tumour even if some patients do not respond to medical treatment and they need a radical surgery for recovery.

INTRODUCCION: El rabdomiosarcoma (RMS) constituye el tumor de tejidos blandos más frecuente en la edad pediátrica, representando el 2-3% de los tumores infantiles. La localización genitourinaria es la segunda en frecuencia tras la cabeza y cuello. El tratamiento suele ser médico, quedando la cirugía como coadyuvante, excepto en casos no controlados en que se precisan cirugías muy agresivas. El objetivo del estudio es analizar los casos de RMS de localización genitourinaria tratados en nuestro Centro y el papel que la cirugía tiene en su tratamiento. MATERIAL Y METODOS: Estudio retrospectivo de 20 pacientes (7 niñas y 13 niños) con una mediana de edad de 24 meses (rango de 1 mes a 12 años) con RMS del tracto urogenital tratados en nuestro Hospital desde 1990 hasta 2012. Se describen variables demográficas, localización del tumor primario, estadio al diagnóstico, tratamiento recibido, tanto médico como quirúrgico, con especial atención al tipo de cirugía realizada y seguimiento en términos de supervivencia. RESULTADOS: La localización del tumor primario fue: vejiga (6), paratesticular (5), vagina (3), retroperitoneo (3), pelvis menor (2) y próstata (1). Todos recibieron tratamiento médico con quimioterapia y radioterapia según protocolo de la Sociedad Internacional de Oncología Pediátrica (SIOP) previa biopsia diagnóstica. La cirugía, practicada en todos los casos como coadyuvante fue: reevaluación por biopsia (1), orquiectomía (5), resección tumoral (8) y cirugía radical (cistoprostatectomía o exanteración pélvica) en 6 pacientes. Hubo 3 fallecimientos, 2 por progresión de la enfermedad y 1 por sepsis postoperatoria. Los 17 restantes están vivos, lo que supone una supervivencia del 80% con una mediana de seguimiento de 14 años. CONCLUSIONES: El RMS es el tumor de tejidos blandos más frecuente en la infancia y la localización genitourinaria la segunda en frecuencia tras las parameníngeas. El tratamiento es multidisciplinar y la cirugía tiene un papel coadyuvante en casos de no respuesta al tratamiento médico o de tumor residual aunque hay pacientes que no responden al tratamiento médico y precisan de cirugía radical para su curación.

[Therapeutic approach in urinary tract stones in children]. / Abordaje de la litiasis en tracto urinario en niños.

PURPOSE: Kidney stone disease in children is a rare pathology, with a low incidence in Spain (1/4,500 hospitalized children). The spontaneous expulsion rate is about 34-47% which means that more of 50% of children need active treatment. Paediatric patients forming urinary stones have a high risk of recurrence, therefore, a standard diagnosis and treatment are needed. We present our experience in urolithiasis treatment in children. MATERIALS AND METHODS: We reviewed retrospectively all the patients ≤ 16 years hospitalized in our hospital with urolithiasis diagnosis from 2000 to 2013, citing treatment modality, stone-free rates and complications. RESULTS: A total of 69 patients with a mean age of 8,2 years (range 1-16 years) were treated in our hospital during that period. The main clinical presentation was pain (52%). The diagnosis was made by abdominal ultrasounds in all cases. About localization, 21 lithiasis were found in distal urether (UD), 8 in medium urether (UM), 3 in proximal urether (UP) and 13 in renal pelvis (PR). The mean size was 13 mm. 21 (30%) patients had a spontaneous expulsion of the stone, 14 (20%) patients were treated with extracorporeal shock wave lithotripsy and in 22 (32%) patients the elected therapy was ureterosopic stone fragmentation (n = 13) or removal (n = 9). No complications were observed. The overall stone-free rate was 79% (n = 55). CONCLUSIONS: Kidney stone disease in children is a rare pathology, with its own features about diagnosis and treatment, which requires medical care in a specialized center. The optimal treatment should be considered regarding the age of the patient, localization and size of the stone, as well as the team experience.

[Laparoscopic pyeloplasty in pediatric patients: our experience]. / Pieloplastia laparoscópica en la edad pediátrica. Nuestra experiencia.

The aim of this essay is to present our initial experience with laparoscopic pyeloplasty and highlight how some specific technical changes allowed us to improve our results. We performed a chart review of the patients that underwent laparoscopic pyeloplasty in our institution. We included patients older than 6 months old with proved stenosis of the ureteropelvic junction. We compared our first patients with the last ones in which we performed laterocolic approach in all left pyeloplasties and included a modification of the technique to place an external ureteric stent. We performed 13 laparoscopic pyeloplasties, 8 male patients and 5 female. There were 3 right pyeloplasties (23%) and 10 left ones (77%). We performed transmesocolic approach in 2 cases (left) and laterocolic approach in 11. Mean surgical time was 184 minutes in the first 8 cases and 142 in the 5 last ones. We had three cases of complications in the first group, two stents migrated to ureter and one postsurgical infection. In the last cases we had a postoperative bleeding. Laparoscopic approach is an effective option for pyeloplasty with similar results to those of the open approach in spite of a longer surgical time. Experience and specific surgical details allow us to reduce complication rate and surgical time.

[Should horseshoe kidneys with associated urological abnormalities be controlled?]. / ¿Deben controlarse los riñones en herradura con anomalías urológicas asociadas?

INTRODUCTION: Horseshoe kidney (HK) is the most common renal fusion anomaly. Urological anomalies (UA) occurs in 52% of HK. The objective of this paper is to know if it's necessary to follow up for a long time the asymptomatic cases of HK with UA. MATERIAL AND METHODS: We reviewed retrospectively 39 cases of children in whom HK was diagnosed in our hospital during 1990 to 2007. The following features have been taken into account: sex, age at diagnosis, associated anomalies, treatment, postoperative complications, results and time of follow-up. RESULTS: The mean age at diagnosis was 3 years. 18 patients (46.1%) had associated urological anomalies: 9 hydronephrosis, vesicoureteral reflux 6 and 3 kidney duplication. 10 cases of them (55%) were surgically treated: 6 pyeloplasty, 2 endoscopic reflux, one upper pole heminephrectomy and one ureteroneocystostomy. 3 hydronephrosis and 3 vesicoureteral reflux were managed conservatively. The ureteropelvic junction obstruction (UJO) was caused by a crossing lower-pole vessel in four cases (67%) and two by a high ureteral insertion. Three of this cases of obstruction (50%) were adquired over the time (along 5-7 years from diagnosis of hydronephrosis). There were no complications and the mean time of follow up has been 3.6 years (range: 2-6 years). CONCLUSIONS: We think that all HK associated with UA should be controlled, as above 50% are subsidiaries of surgical correction. The hydronephrosis can be obstructive over the time and it could be necessary to check them for a long time.

[Which laparoscopic technique is the best to descend intra-abdominal testes?]. / Qué técnica laparoscópica es la ideal para descender los testes intraabdominales?

INTRODUCTION: It's reported that the laparoscopic orchiopexy without vessel transection at one stage (LO1S) is the recommended technique for the testis located near to the internal ring (IR) and orchiopexy in two stages according to Fowler Stephens (2SFSO) for the testicles located far away to the IR .The dilemma arises in those testicles situated on the border between the two procedures. We reported our experience in the management of this disease and analyze our results. MATERIAL AND METHODS: From 2005 to 2007, we have operated to 61 patients and 74 intra-abdominal testes by laparoscopy. The techniques used were the LOIS and the Fowler Stephens orquidopexy with a first stage laparoscopic and a second one inguinal. Differents features have been taken into account retrospectively. RESULTS: Of the 74 testes operated, 16 (21.6%) were located less than 1 cm from IR (group I), 43 (58.2%) between 1 and 2 cm from IR (Group II) and 15 (20, 2%) more than 2 cm from IR. Group I: In all cases were treated with LOIS procedure. We obtained good results in 13 testes (81.2%). Two testes (12.6%) grew less than the other side and one testicle (6.2%) rose to the inguinal canal and it needed new orchiopexy. Group II: In 31 cases (72.1%) was performed a 2SFSO and in 12 (27.9%) a LOIS. Of the 31 testes intervened by 2SFSO in 22 (71.5%) was obtained good results, 6 cases (19.5%) atrophied, 2 tests (6%) grew less than the other side and one testicle rose to upper scrotum (3%) Of the 12 testes in whom the LOIS were performed in 6 (50%) achieved good results, three rose to upper scrotum (25%), one testicle (8.3%) rose to inguinal canal (8.3%) and two cases grew less than the other side (16.7%). Group III: In the 15 tests were treated with 2SFSO procedure. 10 testicles (66%) had a good result. 3 (20%) decreased in size and 2 (14%) orchiectomy was performed by severe atrophy. CONCLUSIONS: The LOIS offers good results for testis located near to the IR. The most frequent complication of this technique is the ascend of the testes and the most one in the 2SFSO is the testicle atrophy. The surgeon's experience will play an important role in the final decision on the technique ideal in the intra-abdominal testis situated on the border between the two procedures.

[Surgical treatment of congenital mesoblastic nephroma]. / Tratamiento quirúrgico del nefroma mesoblástico congénito.

BACKGROUND: Renal tumors are rare in infants less than 6 months of age, being congenital mesoblastic nephroma the most frecuent in this age group. We reported 4 cases treated in our hospital in the last years. METHODS: We analyze age, sex, the clinical presentation as well as diagnosis and treatment. RESULTS: Range of age at diagnosis was 0-6 months. In our study the predominant sex was female. Clinical presentation was abdominal mass in all of cases with hypertension (HTA) in two of them. Scan ultrasound has been the method of dignostic, that was completed with Magnetic Resonance Imaging (MRI). The tretament was open surgery in three cases and laparoscopic on the last. All patients are alive with no evidence of disease. CONCLUSIONS: Low frecuency of this tumor limit the experience on diagnostic and treatment. Standard treatment is nephroureterectomy radical with free margins. Adjuvant therapy should be considered in recurrent disease although exists few studies. Laparoscopic surgery should be an alternative to clasical treatment since permits excision with good security margins.

[The lithiasis in the upper urinary tract in children: endourological treatment]. / Tratamiento endourológico de la litiasis del tracto urinario superior en la infancia.

INTRODUCTION: Urolithiasis in the pediatric age is a growing problem. In the developed world they are of calcium oxalate and in the upper urinary tract. It is very similar to the presentation of lithiasis in adults, so we have to make an effort to apply the experience in this age to the children. The shock wave lithotripsy is admitted as the first treatment for this pathology in the pediatric population already. The endourological approach must be use as a common approach in this group. We present our technique and experience. MATERIAL AND METHODS: A retrospective, descriptive study of the children diagnosed of lithiasis in the upper urinary tract that were treated by an endourological technique in our centre between January 1992 and January 2005. We gathered data on: 1.) Preoperative: age, sex, clinical manifestations, size (mm) and position of the lithiasis (we divided the upper urinary tract in: renal, proximal third, medial third and distal third) 2.) Operative variable: endourological technique: percutaneus neprolithotomy or ureteroscopy. Reconversion to open surgery. 3.) Postoperative variables: time since surgery, complications and the current state of the patient (ultrasonography and renal function). RESULTS: Seven children, 4 boys and 2 girls with an age range of 2,5 to 14 years, underwent operation using an endourological technique. Lumboabdominal pain was the main clinical manifestation (4/7). The lithiasis size was 4-7mm, with the exception of a staghorn calculis. The calculis were: 5 ureteral proximal, 1 ureteral distal and one in the kidney (staghound stone). We performed one percutaneus neprolithotomy for the staghorn calculi. We removed completly the stone and had no complications. The 6 other procedures were ureteroscopies. In 3 of them we removed the calculi (4/7 success rate of 57%). The rest procedures we needed to transform in open surgery. With a following time of 1-13 years all of them are asymptomatic, and with ultrasonography and renal function in the normal limits. We did see no complications. CONCLUSION: The endourological treatment for urolithiasis in pediatric patients is possible but must be individualized in each case. With the development of new endourological material and more surgical experience this technique will be to the reach of the most of the urologists.

[Endourological treatment of pelviureteric junction obstruction in paediatric patients: our experience]. / Tratamiento endourológico de la estenosis pieloureteral en la edad pediátrica: nuestra experiencia.

UNLABELLED: Endourological treatment of pelviureteric junction obstruction in paediatric patients: our experience. INTRODUCTION: Pelviureteric junction (PUJ) obstruction is the most common cause of hydronephrosis in the infancy. The gold standard of treatment is open pyeloplasty, but there is an ever greater tendency towards minimally invasive procedures. We present our serie of paediatric patients with endourologically treated PUJ obstruction, together with a review of the literature. MATERIAL AND METHODS: Retrospective, descriptive study of the children diagnosed of PUJ obstruction who were treated by an endourological technique in our centre between January 1988 and January 2005. We gathered data on 3 periods of time: 1st. Presurgical: age, sex, previous treatment, ultrasound (USS) and nuclear medicine (MAG-3) studies; 2nd. Surgical: type of procedure; 3rd. Surgical: recurrence or not and its treatment, and the current state of the patient. RESULTS: Seven children, with an age range of 13 months to 14 years, underwent operation using an endourological technique. The treatment was secondary in five of these patients, after open pyeloplasty, and was primary in 2 cases. The preoperative USS showed grade III dilatation in 3 and grade IV dilatation in 4, and the MAG-3 study showed type II curves in 6 and a type IIIb curve in 1. Three percutaneous endopyelotomies were performed and, by the retrograde approach, 3 balloon dilatations and one Acucise. With a mean follow-up of 37 months, 2 cases of recurrence (both in patients receiving secondary treatment) have been observed, one in whom a retrograde technique (balloon dilatation) was used and the other in a patient treated by an antegrade technique. The remaining five patients are asymptomatic and show no evidence of recurrence (71% of the patients). CONCLUSION: The endourological treatment of PUJ obstruction in paediatric patients is possible but must be individualised in each case. Larger, prospective studies need to be performed in order to reach conclusions.

[Megalourethra in association with VACTER syndrome]. / Megalouretra asociada a síndrome de VACTER.

The megalourethra is an uncommon congenital anomally. It is a consecuence of the abnormal development of the corpus spongiosum and, occasionally, also the abnormal development of the corpora cavernosum. It is specially common in association with the Prune-Belly syndrome, and with upper tract abnormalities. We present a bizarre case because of its association with a VACTER syndrome.

[Prognostic value of the ultrasound visualization of the bulging agent after endoscopic treatment of vesicouretal reflux]. / Estudio del valor diagnóstico de la visualización ecográfica del material inyectado en el tratamiento endoscópico del reflujo vesicoureteral.

INTRODUCTION: The endoscopic treatment of vesicoureteral reflux constitutes an easy and simple option at the moment for its resolution in all degrees and ages. It is necessary to carry out an ECO and VCUG (vesical cystouretrography) during voiding to verify their resolution. The ultrasongraphy can detect the wheal of injected material (Teflon or Macroplastic), but it is ignored if its visualization implies its disappearance or not. OBJECTIVE: To see the correspondence or not between the sonographic presence of injected material wheal and disappearance of reflux in the VCUG. MATERIAL AND METHODS: It has been statistically selected a sample of convenience to calculate the sensibility and specificity of the sonographic visualization of the endoscopic injected material wheal. We have studied 115 ureters with all the reflux degrees and ages, chosen randomly among patients treated endoscopically of vesicoureteral reflux, independently of the injected material, polytetrafluoroethylene (Teflon) or polydimethylsiloxane (Macroplastic). Refluxes due to duplex systems and those in which there were doubts of their correct installation during endoscopy were rejected. Cases with two or more injections were rejected too. The ECO and corresponding cystographies were revised in the first control after treatment (three months later). With this data, a chart of 2X2 was built comparing the presence or not of wheal in the ECO with the presence or not of reflux in the VCUG. We calculate sensibility, specificity, PPV (positive predictive value) and NPV (negative predictive value) as well as the degree of agreement of both tests with the kappa index. RESULTS: In 115 ureteral units we visualized with ECO the wheal of injected material in 97 and not in 18 (16%). In those cases with visualized wheal, reflux disappeared in 59 (61%), and in 38 not (39%). In those cases where the wheal was not visualized, reflux disappeared in 13 and persisted in other 5 (28%). The degree of sensibility was 12%, the specificity 82%, the PPV 22% and the NPV 61%. CONCLUSIONS: Attending to the low specificity and predictive values, the sonographic presence of material wheal doesn't indicate that the reflux has been corrected, as well as its absence doesn't reflect the presence of the same one, being always necessary to carry out a cystography for its diagnosis.

[Nephroblastomatosis: which therapeutic approach should be used? Report of 2 cases]. / Nefroblastomatosis: qué actitud terapéutica a seguir?. A propósito de 2 casos.

Nephroblastomatosis is a complex of pathological conditions defined by the persistence of nephrogenic elements after the conclusion of nephrogenesis (beyond week 36 of gestation) that conserve the capacity to evolve into nephroblastoma. Luckily, this malignant transformation is exceptional (< 1%(1)), which is why the disease is considered to have a good prognosis. The nephrogenic remains are frequently associated with beckwith-Wiedemann syndrome, hemihypertrophy and aniridia, in which case there is a greater risk of the development of Wilms tumor. Consequently, these children must be followed-up closely. The difficulty lay in knowing when to act, which children should be treated, and what treatment is appropriate because what little has been published in the literature is debatable. We report the cases of two patients, one with unilateral nephroblastomatosis and the other bilateral, who required surgical treatment after not responding to chemotherapy; and we expose our therapeutic algorithm and follow-up strategy.

[Reduction of the hospital stay in the surgical treatment of hydronephrosis in children]. / Reducción de la estancia hospitalaria en el tratamiento quirúrgico de las hidronefrosis en la infancia.

UNLABELLED: A Hydronephrosis operation represents a relatively frequent surgery in childhood. There is not agreement about the necessity of using drainage neither on the type to use, decisions that rebound in the patient's hospital stay. The objective of the study is to show the reduction of the days of stay according to the type of drainage used. MATERIAL AND METHODS: We present 14 children diagnosed of hydronephrosis operated on by Anderson-Hynes technique with an internal drainage double J type no 3 or 4. There were left side predominance (10 kidneys). Age of diagnosis varied from 0 to 11 years. We analysed the decrease of the stay with regard to the system that we used previously, nephrostomy drainage and stent, as well as the presence of complications related with the drainage. A cystoscopy was performed fifteen days later, in ambulatory way, to remove the catheter. A questionnaire of satisfaction was requested to the parents. RESULTS: Thirteen patients abandoned the hospital 2 days postoperatively and 2 three days postoperatively. There were 3 complications, being 2 minor and 1 mayor (double J ascension removed by ureteroscopy and an additional one day stay hospital). The reduction of the stay with regard to the traditional method varied between 7 and 8 days what represents an important saving of costs. In the questionnaire, the methods has appealed to the parents. CONCLUSION: We believe that the placement of a double J catheter represents an improvement that saves time and diminishes nuisances to patients, although a cystoscopy procedure is necessary for its removal. The double J catheters with a straight prolonged end, like a nephrostomy tube, recently in the market can avoid this last procedure.

[Is it necessary to use an isotopic diuretic renogram in grade II pyelocaliceal dilatations diagnosed with ultrasonography?]. / Es necesario efectuar un renograma isotópico diurético en las dilataciones pielocaliciales grado II ecográfico?

PURPOSE: The increasing number of ultrasonographically detected asymptomatic, renal dilations have caused a lot of explorations to be performed in these patients. The Society of Fetal Urology proposed a four grades classification of echographic renal dilations and renographic studies are recommended in grades II to IV. However we have observed that grade II dilations don't evolve to obstruction. The aim of this work is to evaluate the obstruction rate in this group of patients, and the necessity or not of practising diuretic renography. MATERIAL AND METHODS: We studied 42 children diagnosed of grade II renal dilation during a 1.5 year period. Left side was more frequently affected, 23 cases, 7 cases were bilateral what means 49 affected renal units. There was a male predominance (69%). Mean age at diagnosis was 2 months (0 to 36 months). Seventy nine per cent were prenatally diagnosed. RESULTS: The MAG-3 renal scan showed 48 unobstructed renal units and 1 obstructed. The F-15 variant was made in 15 cases by a doubtful curve or retarded elimination. The patient with obstructive curve presented an 15 mm renal pelvic diameter echographically measured and the intravenous urography showed a higher dilation being operating on. The mean time follow up was 23.5 months (13 to 53 months) without any change. CONCLUSION: Grade II pielocalicial dilations with renal pelvis lesser than 15 mm can be echographically controlled without renal scan. It should be performed only if renal dilation increases.

[Diagnostic comparison of diuretic isotopic renogram and diuretic Doppler ultrasonography in pediatric hydronephrosis]. / Comparación diagnóstica entre el renograma isotópico diurético y el Eco Doppler diurético en las hidronefrosis infantiles.

UNLABELLED: Due to the high frequency of asymptomatic pyelocaliceal dilatations, most of them with prenatal diagnosis, the diagnosis of obstruction remains a major chance. Isotopic diuretic renogram (IDR) remains the basic diagnostic tool, although it has some pitfalls and undetermined diagnosis. To obviate them, several others tests have been used, such as diuretic Doppler ultrasound (DDU). The object of this paper is to determine its validity. METHODS: All the patients with hydronephrosis and with grade II dilatation or bigger were studied wit DDU. The results were compared with those obtained by IDR, obtaining 2 x 2 tables to analyze specificity and sensibility. RESULTS: 37 patients were studied, 9 of them bilateral, with a total of 46 dilated kidneys. There were 22 males and 15 females. 59 percent had prenatal diagnosis and 57 percent were asymptomatic. 22 percent had grade IV dilatation, 37 percent grade III and 41 percent grade II. 2 cases had contralateral vesicoureteral reflux. IDR showed 15 obstructed kidneys, 7 of them with a regular renal function. 16 were operated, one more due to abdominal pain despite a non-obstructed IDR. Only 7 of the 15 kidneys presented an obstructive pattern in the DDU. Comparing both tests, DDU had a 46 percent of sensibility and 100 percent of specificity and a negative predictive value of 79% for a 95% interval. Kramer index was 0.54 representing a very low association. CONCLUSIONS: In our institution, DDU is not better than IDR to diagnose obstruction. We consider its use as a second line test in cases of doubtful IDR.

[Testicular tumors in childhood. Review of cases in the course of 13 years]. / Tumores testiculares en la infancia. Revisión de 13 años.

Testicular and paratesticular tumors are rare in childhood, representing 1-2 percent of the solid tumors in the pediatric age. In patients under 14 years, the incidence is 0.5-2/100,000. The evolution differs from that of the adult. Since 1981 to 1994 we have treated 14 cases of testicular and paratesticular tumors. Mean age was 2.54 years, the younger patients presenting germinal tumors. The most frequent tumor was the yolk sac tumor (36%), followed by teratoma mature (29%), and Leydig cell tumor, epidermoid cyst, paratesticular fibrous hamartoma, paratesticular neuroblastoma and paratesticular rabdomyosarcoma (7% each). A testicular mass was present in all cases (100%). Testicular ultrasound was used in 100%. In all the patients with malignant tumors a thoraco-abdominal CT scans was done to rule out extension or the tumor, being negative in all cases. Alphafetoprotein were high in all the cases of yolk sac tumor, being within normal range one month after surgery except in one case. In 11 patients an orquiectomy was done through an inguinal approach, and in three cases a simple tumorectomy without orquiectomy. No lymphadenectomy was done. All the malignants neoplasms were stage I tumors, except one yolk sac tumor stage III. Postop chemotherapy was applied in this one and in the embrionary rabdomyosarcoma. There were no recurrences after a follow-up mean time of 3.98.

Diuresis renography in the diagnosis and follow-up of nonobstructive primary megaureter.

Due to the widespread use of obstetrical ultrasonography with concomitant fetal screening, congenital uropathies are usually diagnosed in asymptomatic neonates. The main issue is to distinguish those cases of dilatation which are clearly obstructive and need surgical treatment from those which are within the normal anatomical range. Out of 47 patients with primary megaureter, 23 were nonobstructive and these are the subject of our study. There were 16 males and 7 females. Thirteen were located on the left side, 7 on the right side and 3 were bilateral, adding up to 26 renoureteral units. Prenatal diagnosis was made in 16 cases, the oldest patient diagnosed was 9 years old. All infants were evaluated with ultrasonography, voiding cystourethrography, excretory urography and diuresis renography. The latter has been the most important test inducing us to adopt a conservative attitude. Differential renal function was more than 40% in 24 units and in 2 it was more than 35%. Diuretic renograms were type IIIa (dilated, nonobstructed) in 19 cases and IIIb (dilated, partially obstructed) in 7. There were 2 cases with vesicoureteral reflux in the contralateral system. We performed ultrasonography and diuresis renography during the follow-up. There were 8 cases with type I (normal) renograms and 17 cases with type IIIa. Only one patient developed an obstruction and was operated on. Differential renal function did not deteriorate in any of the cases. Urography was performed in 9 cases during the follow-up. All the patients have remained asymptomatic during the surveillance, except for 2 cases which presented urinary tract infection. BUN, creatinine and other biochemical figures remained within the normal range. The follow-up period of time ranged between 1 and 8 years. We conclude that primary megaureter must be assessed and followed up and that the main test to be used is diuresis renography.

[Surgery of ectopic ureterocele in children: strategy based on prenatal function]. / Tratamiento quirúrgico del ureterocele ectópico en la infancia: estrategia basada en la función renal.

From 1981 to 1993, we have treated 31 pediatric patients with ectopic ureterocele (associated to duplex system, intra and extravesicals). Diagnostic work-up included abdominal ultrasound, intravenous urography (IVU), sequence mictional cystouretrography (SM-CU) and diuresis renography (DTPA-DMSA o MAG-3). Patients were divided in two groups: 1. Good renal function in the affected system (5 cases) with 2 endoscopic incision of the ureterocele and 3 without surgical treatment (all intravesical). 2. Almost non-existent ipsilateral renal function (26 cases), treated by heminephrectomy and ureterocelic aspiration, and in the remaining a nephrectomy was done for ipsilateral non-existent renal function. 2 cases treated by endoscopic incision presented vesicoureteral reflux, and 4 cases treated by nephrectomy had a low grade reflux. There is no a definite treatment established. The choice should by made based on renal function. Endoscopic incision is a good choice in obstructed cases with good renal function. In those with no function at all, heminephrectomy with aspiration of the ureterocele will be the best treatment if we consider that almost 50 percent of the patients will need a second surgical procedure.

[Clinical course of primary non-obstructive megaureter: analysis of our series]. / Evolución del megauréter primario no obstructivo: análisis de nuestra serie.

Due to the widespread use of obstetrical ultrasonography with concomitant fetal screening, congenital uropathies are usually diagnosed in asymptomatic neonates. The main issue is to distinguish those cases of dilatation which are clearly obstructive and need surgical treatment from those which are within the normal anatomical range. Out of 47 patients with primary megaureter, 23 were nonobstructive, these are the aim of our study. There were 16 males and 7 females; 13 were located on the left side, 7 on the right side and 3 were bilateral, adding up to 26 reno-ureteral units. Prenatal diagnosis was performed in 16 cases, the eldest patient diagnosed was nine. All infants were evaluated with ultrasonography, voiding cystourethrography, excretory urography and diuresis renography. The latter has been the most important test inducing us to adopt a conservative attitude. Differential renal function was more than 40% in 24 units and in 2 was more than 35%. Diuretic renograms were type IIIa (Dilated non obstructed) in 19 cases and IIIb (Dilated partially obstructed) in 7. There were 2 cases with vesicoureteral reflux in the contralateral system. We have performed ultrasonography and diuresis renography during the follow-up. There were 8 cases with type I (Normal) renograms and 17 cases with type IIIa. Only one patient developed an obstruction and was operated on. In every case differential renal function did not deteriorate. In 9 cases urography was performed in order to see the anatomical changes. They have remained asymptomatic during the follow-up except for two cases which presented urinary tract infection. BUN, creatinine and other biochemical figures remained within normal ranges.(ABSTRACT TRUNCATED AT 250 WORDS)