[Sigmoid colon vaginoplasty: experience with five cases]. / Vaginoplastia con sigma: a propósito de 5 casos.

Vaginal atresia compounds a rare congenital anomaly and results from anomalies in the development of Müller ducts as happens in the Mayer-Rokitansky syndrome or in other cases of intersexual states. Some different tissues have been issued for the creation of a neovagina, but none of them has been accepted as ideal. We have chosen sigmoid colon in order to create a new vagina functionally appropriate. We present five cases affected of vaginal atresia. Two of them were Mayer-Rokitansky syndromes and the other were diagnosed during the study for primary amenorrhea as a result of an intersexual state. In all cases a vaginoplasty was performed according to Baldwin's technique in the ages between 15 and 20 year-old. The follow up has been from 1 to 16 years. No postoperative complications have been observed. The external aspect of the genitalia is normal and a proper sized with length and lubrificated vagina was attained in all cases without any retraction in any patient. Two of the patients maintain sexual relations without problems. In our experience, the cosmetic and functional result of sigmoid vaginoplasty were excellent.

[Good results with Passerini's technique in severely masculinised female pseudohermaphroditism]. / Buenos resultados empleando la técnica de Passerini en pseudohermafroditismos femeninos con virilización severa.

In female pseudohermaphroditism due to congenital adrenal hyperplasia (CAH), some cases develope a very important masculinization degree with a high outlet of the vagina above the outern urethral sphincter. There are several surgical techniques to solve this problem. Our group uses Passerini's thecnique since 1990. 9 Girls with CAH with extreme masculitation (IV and V Prader degree) have been operated with this technique. The age at intervention varies between 9 months and 3 years, with a follow-up between 1 and 12 years. All these patients had hormonal studies, demostrating a deficiency of 21-hydroxilase in 8 cases and a deficiency of 11-B-hydroxilase in one case. To determine the vaginal outlet a genitography was performed in all cases, vaginoscopy in 7 cases and MNR in 2 cases. Passerini's technique consists of two phases: the first step has the objective of forming the distal 2/3 of the vagina using the skin and the urethral mucosa of the phallus. At the second time transtrigonal way is performed to access the vagina which is desinserted from its urethral outlet and anastomosed with the distal neovagina. There were no significative complications in immediate time. The esthetic result is acceptable in all cases, although one case had to be surgically repaired because of a prominent vulvar flap. We use vaginoscopy to prove vaginal permeability in all cases although one of them developed adherences around the anastomosis. This severe genital malformation, very uncommon, has a difficult surgical solution. Passerini's technique allows, with less complications, to create an acceptable outer genitals at early age and only in one surgical time.

[Ten years of prenatal diagnosis of uropathies. Study and conclusions]. / Diez anños de diagnóstico prenatal de uropatías. Estudio y conclusiones.

Since uropathy started to be diagnosed by means of ultrasonography during the prenatal period, paediatric urologists have experienced a major increase in neonatal consultations, which involve healthy children without any symptoms of urinary tract infection. Thereby the criteria for an adequate treatment of these uropathies have been modified. With our study, we intend to analyse the changes regarding the management of such cases in our Service for the last 10 years. 294 cases prenatally diagnosed and confirmed by means of postnatal sonography have been reviewed, taking into account the type of explorations carried out in order to obtain a definitive diagnosis. Ultrasonography, cystourethrography, pyelography, scintigraphy and isotopic renography have determined both degree of obstruction and the renal function of the patient so as to value the kidney viability. We have found 169 cases of pelviureteral junction (PUJ) obstruction, 52 of vesicoureteral reflux (VUR), 48 of megaureter, 13 of ureterocele, 8 of ectopic ureter, 5 of urethral valves, 26 of multicystic dysplasic kidney, 35 of renal duplication, 4 of renal cyst, 2 of ectopic kidney, 2 of renal agenesia, 3 of bladder diverticular, 1 of renal hypoplasia and 1 of Bolande's tumour. 32 children were operated upon due to PUJ obstruction, 27 due to VUR, 14 megaureter, 21 due to ureterocele and ectopic ureter, 5 due to valves, 5 multicystic kidneys, 3 vesical diverticula, 2 renal cysts and 1 due to Bolande's tumour. From a total of 367 diagnoses, 109 patients have undergone an operation, which equals a 29.7%. The rest of the patients have been subject to a medical follow-up. Only 3 patients had to be operated on due to an aggravation of their obstruction. To sum up, the main advantage of prenatal diagnosis is that it presents the patient without urinary infection. Double-diuretic scintigraphy has proved to be the best option to explore the obstruction when dilated despite its limitations in the case of deficient renal function. The most frequent diagnosis, which has undergone a major increase in the last few years, is PUJ obstruction in the manner of pyelic dilatation. Many of them are not confirmed postnatally and most of them (more than 70%) do not need surgical treatment.

[Anterior urethral valves]. / Válvulas de uretra anterior.

The valves of the anterior urethra are a rare congenital malformation, but it can cause a significant deterioration of the uppermost urinary system due to their obstructive patterns. It's placed fundamentally in the peno-scrotal union or in the bulbous urethra. They can associate to the diverticula of the anterior urethra. The clinical manifestations can be varied, depending upon the age of the child and the degree of obstruction that provoque. The treatment is always surgical, although in some occasions they suffice the endoscopic resection. We present the 12 cases controlled in our Center, with known ages between 1 month and 7 years, that began with tumefaction urethral at micturition in 7 cases, urinary infection in 6 and sepsis in 2. All of them required open surgery, after the failure of endoscopic resection in one of them. The results have been favorable in 9 cases regarding to the repercussions in the renal function. Two patients had a need of nephrectomy and one had to be subjected to a renal transplantation. The jet at micturition after surgery is good in 10 cases. In one, there persists a subtle jet, although without clinical repercussions, and in one patient there appeared a slight dilation in the posterior urethra.