[Uroflowmetric review of pediatric distal urethroplasty]. / Revisión uroflujométrica de pacientes intervenidos de hipospadias distales.

INTRODUCTION: Urethral stricture is the most common complication in hypospadias surgery. The monitoring of operated patients allows rapid detection of this complication and the uroflowmetry is the main diagnostic method. OBJECTIVES: To study of functional results in patients who underwent distal urethroplasty, using uroflowmetry. PATIENTS AND METHODS: A retrospective chart review was conducted of 81 patients who underwent distal hypospadias repair (7 coronal, 51 subcoronal and 23 distal penile shaft) and a postoperatory uroflowmetric study. The patients were divided into two groups, in each type of hypospadias, according to the presence or absence of stenotic complications (0 coronal, 10 subcoronal and 5 distal penile shaft). The functional effects in both groups were studied. RESULTS: All patients with stenotic complications showed maximum flow rates and mean flow rates below 15 and 20 percentiles respectively and a plateauing layout of the urinary flow curve. The treatment of these conditions resulted in the normalization of the maximum flow values ​​(in 100% of the subcoronal and 100% of the distal penile shaft hypospadias), as well as in the mean flow values ​​(in 88% of the subcoronal and 75% of the distal penile shaft hypospadias). The curve also adapted a bell-shaped in 100% of the H. coronal and 50% of the H. distal penile shaft. The uroflowmetry presented a spontaneous improvement in all patients without stenotic complications but with low flows in their first uroflowmetric. CONCLUSIONS: Uroflowmetry is an objective method for the evaluation of hypospadias surgery, being easy to perform, noninvasive and reliable. Obstructed uroflow patterns point to the presence of a stenotic complication.

INTRODUCCION: La estenosis uretral es la complicación más frecuente de la cirugía del hipospadias. El seguimiento de los pacientes intervenidos permite su rápida detección, siendo la uroflujometría su principal método diagnóstico. OBJETIVOS: Estudiar la repercusión funcional, mediante la uroflujometría, en pacientes intervenidos de hipospadias distal. MATERIALES Y METODOS: Se presenta un estudio descriptivo, retrospectivo, en el que se revisaron las historias clínicas de 81 pacientes intervenidos de hipospadias distal (7 balánicos, 51 balanopeneanos y 23 peneanos anteriores) y a los que les realizaron estudios uroflujométricos. En cada tipo de hipospadias, se dividieron los pacientes en dos grupos según la presencia de complicaciones estenóticas (0 balánicos, 10 balanopeneanos y 5 peneanos anteriores) o la ausencia de estas y se estudiaron las repercusiones funcionales en ambos grupos. RESULTADOS: Todos aquellos pacientes con complicaciones estenóticas presentaron flujos máximos y medios por debajo de los percentiles 15 y 20 respectivamente, así como un trazado de la curva anormal. El tratamiento de estas complicaciones estenóticas se tradujeron en una normalización tanto en los valores de flujo máximo (en el 100% de los hipospadias balanopeneanos y en el 100% de los hipospadias peneanos anteriores), como en los valores de flujo medio (en el 88% de los hipospadias balanopeneanos y el 75% de los hipospadias peneanos anteriores). La curva, además, adaptó un trazado en forma de campana en el 100% de los hipospadias balanopeneanos y el 50% de los hipospadias peneanos anteriores. Se detectó una mejoría uroflujométrica espontánea en aquellos pacientes que, sin complicaciones estenóticas, presentaron en su primer control uroflujométrico flujos bajos. CONCLUSIONES: La uroflujometría es un método objetivo para la evaluación de la cirugía del hipospadias, siendo una técnica fácil, reproducible y no invasiva. Los parámetros uroflujométricos bajos indican la presencia de una complicación estenótica.

Neurogenic bladder in children: urodynamic studies and results with medical conservative treatment.

We present the urodynamic findings and therapeutic results in 25 children with neurogenic bladder, ranging in age from 2 months to 14 years. We observed a significant reduction of urinary infections and vesicoureteral refluxes following medical treatment based on the urodynamic findings. Furthermore, we observed a worse evolution in patients with pre-voiding bladder pressure in excess of 50 cm H2O, incontinence being more difficult to treat in children with urethral closure pressure profile below 47 cm H2O. In our series, anticholinergic treatment improved hypertonia and hyperreflexia which disappeared in 66.6% of cases. Total continence was achieved in 37.5% and improved in 29.1% of children.

[The study of urinary flow in 3 to 14 year-old children. Urinary flow rate nomograms]. / Estudio del flujo miccional en niños de 3 a 14 años. Nomograma uroflujométrico.

A descriptive analysis of 1361 uroflowmetries carried out in healthy children of both sex aged 3 to 14 years is reported. Maximal flow rate (Qmax), average flow rate (Qave), flow time (tQ), and maximal flow time (tQmax) are expressed as a function of body surface (sc) and urinary output volume. It is found that tQ increases as the urinary output volume does and decreases as sc becomes greater, tQ values being higher in males. Qmax and Qave are higher in females and run parallel to sc and urine volume. Comparison between both sex shows significant differences in Qmax values. Study of urinary flow curves reveals a normal pattern in more than 90% of samples. A percentile nomogram is developed for Qmax and Qave as a function of urinary output volume, sex and body surface.

[Primary varicocele in children. The surgical indications]. / Varicocele primario en el niño. Indicaciones quirurgicas.

Varicocele is an abnormal dilatation of the veins of the pampiniform plexus. It is a commonly diagnosed finding due to the augmentation of pediatric age in our institutions and to the better routine physical examinations. The influence of varicocele on infertility is very well known, because of oligospermia and low motility of the sperm. There are controversy on surgical indications in children, because the absence of semen analysis. Do we have to operate all patients with varicocele or only those with symptoms? We review 16 cases with varicocele, 9 of those underwent surgery. The surgical indications were those patients with scrotal pain, stage II and III of varicocele classification and patients with lesser size of ipsilateral testis. Surgical procedures were high ligation of spermatic veins in all cases. Clinical evolution hsa been excellent, up to date.

[Fascia lata transplant from cadaveric donor in the reconstruction of abdominal wall defects in children]. / Injerto de fascia lata de donante cadáver en la reconstrucción de defectos de pared abdominal en niños.

INTRODUCTION: Abdominal wall closure is not possible in large congenital defects, even after extensively stretching in to enlarge its capacity. The skin coverage is usually adequate but the aponeurotic defect has to be closed temporally using synthetic patches. The use of these materials leads to increase complication such as infection, fistula formation and extrusion. In addition a second operation is required to remove the material and to perform a definitive closure. The role of fascia lata in reconstruction of abdominal wall is well established as free grafts, pedicled flaps or free flaps. Bank cadaveric fascia lata is used extensively in neurosurgical, ophtalmological, orthopaedic and urogynecological procedures. This is the first description of the use of cadaveric fascia lata for the closure of large abdominal wall defects. CASE REPORTS: We present two cases of congenital diaphragmatic hernia. The first patient was a newborn who presented the impossibility to close the fascia, that was salvaged by a teflón patch. Five months later the wound opened, leaving the mesh exposed that had to be removed. A cadaveric fascia lata patch was used to cover the defect, closing the skin satisfactorily. The second case was a two days newborn. We performed the diaphragmatic closure, and the aponeurotic defect was closed using cadaveric fascia lata. RESULTS: Cosmetic and functional appearance are satisfactory in both cases and no complications have been seen. CONCLUSION: Fascia lata patches are revascularized in the abdominal wall and incorporates into receptor tissue. They have the following advantages with respect to synthetic materials: First, the risk of complications is lower. Second, their removal is not necessary. Finally, no intraperitoneal adhesions occur. The risks of disease transmission and rejection are minimized by the Centro Comunitario de Transfusiones donor selection and processing of the cadaveric fascia lata.

Urine flow in childhood: a study of flow chart parameters based on 1,361 uroflowmetry tests.

PURPOSE: We attempted to analyze the parameters of the urine flow chart in children. MATERIAL AND METHODS: We evaluated 1,361 uroflowmetry tests of healthy boys and girls, analyzed voided volume in relation to age and body surface area, and made a descriptive study of flow chart parameters. Analysis of variance was used for comparative study of these parameters in sex, age and body surface area groups. RESULTS: Mean values of maximum and average flow increased with voided volume, patient age and body surface, and they were higher in girls. However, mean values of flow time and time to maximum flow were higher in boys. Flow time increased with volume, and decreased with age and body surface, although time to maximum flow increased slightly with volume and did not change with age in boys or girls. CONCLUSIONS: Generally, we noted significant differences in maximum and average flow, and flow time and time to maximum flow in the different age groups and in both sexes. Regarding flow curve shape, a normal flow pattern (bell-shaped curve) was noted in more than 90% of cases. The plateau curve was apparent in 5.2 and 0.7% of boys and girls, respectively.

[Foreign body aspiration in childhood. Review of 210 cases]. / Broncoaspiración de cuerpos extraños en la infancia. Revisión de 210 casos.

AIM: Foreign body aspiration is one of the accidents with highest incidence, morbidity and mortality in childhood. It is favoured by curiosity and the immature swallowing mechanisms of this age group. To determine the most common signs and symptoms leading to the diagnosis of foreign body aspiration and to demonstrate the diagnostic value of a detailed anamnesis, we analyzed the cases of foreign body aspiration treated in our hospital between 1975 and 1997. MATERIALS AND METHODS: Retrospective study of 210 patients with suspected foreign body aspiration. In 208 patients rigid bronchoscopy was performed. Evidence of a foreign body was found in 90%. RESULTS AND CONCLUSIONS: We emphasize the clinical value of thorough anamnesis which showed high sensitivity (80%) in choking crises and persistent cough. Physical examination and respiratory auscultation showed high sensitivity (90%) but low specificity (16%). Chest X-ray showed the lowest sensitivity with 16% of false negatives. Most foreign bodies were vegetable fragments (82%), with a complication rate of 5.7%. Mortality was 0.9%, with no deaths occurring in the last 8 years.