[Laparoscopic repair of inguinal hernia and communicating hydrocele in children. Our experience in the last years]. / Reparación laparoscópica de la hernia inguinal e hidrocele en edad pediátrica. Nuestra experiencia en los últimos años.

INTRODUCTION: Laparoscopic inguinal hernia and hydrocele repair has become an alternative to the more frequently used inguinal approach. We describe our experience with the laparoscopic technique. MATERIAL AND METHODS: Retrospective study of laparoscopic inguinal hernia and hydrocele repair performed during the period between 2003-2016. We included patients < 14 years, with communicating hydrocele and/or indirect inguinal hernia diagnosis (N = 39). We have studied two cohorts; group A patients with indirect inguinal hernia (N = 31) and group B patients with communicating hydrocele (N = 8). We used intraperitoneal laparoscopic approach, performing herniorrhaphy of the internal inguinal orifice without resection of the hernial sac. The main outcome measurements were surgical indication and postoperative complications. RESULTS: The indication for laparoscopic repair was bilateral defects (46.2%), unilateral defects (28.2%), defects associated with umbilical hernia (23.1%) and associated with another pathology (2.6%). In group A the rate of complications that required new admission was 3.2% and the recurrence rate was 9.7%. In group B, was 12.5% ​​and 12.5% respectively. We have not observed a significant relationship with respect to patient age, laterality or suture used and the rate of complications in any of the groups. CONCLUSIONS: Despite the limitations of our study given the small sample size and retrospective nature, the complication rate (15%) is higher than that published in the literature. This makes us take a step back to reassess our indications and technique, and not forget that the laparoscopic approach is not a technique without risks and requires a learning curve.

OBJETIVOS: La reparación laparoscópica de la hernia inguinal e hidroceles en la edad pediátrica, se ha convertido en una alternativa a la herniorrafia inguinal clásica. Describimos nuestra experiencia en las intervenciones realizadas con dicha técnica. MATERIAL Y METODOS: Estudio retrospectivo de las reparaciones laparoscópicas de hernia inguinal e hidrocele realizadas en el periodo 2003-2016. Se han incluido pacientes <14 años, diagnosticados de hidrocele comunicante y/o de hernia inguinal indirecta (N=39), divididos en dos cohortes: grupo A pacientes con hernia inguinal indirecta y grupo B pacientes con hidrocele comunicante. Se ha empleado el abordaje laparoscópico intraperitoneal, y anillorrafia del orificio inguinal interno sin resección del saco herniario. Las variables principales estudiadas han sido la indicación quirúrgica y las complicaciones postquirúrgicas. RESULTADOS: Las indicaciones quirúrgicas han sido los defectos bilaterales (46,2%), defectos unilaterales (28,2%), defectos asociados a hernia umbilical (23,1%) y asociados a otra patología (2,6%). En el grupo A la tasa de complicaciones que precisaron de ingreso fue de 3,2% y la tasa de recurrencias fue de 9,7%; mientras que en el B han sido del 12,5% y del 12,5% respectivamente. No hay una relación significativa respecto a la edad, la lateralidad o la sutura utilizada y la tasa de complicaciones en ninguno de los grupos. CONCLUSIONES: A pesar de las limitaciones del estudio, el porcentaje total de complicaciones (15,3%) es más elevado que el publicado en la literatura. Esto nos hace reflexionar y no olvidar que el abordaje laparoscópico no es una técnica exenta de riesgos y requiere de una curva de aprendizaje.

[Early parenteral nutrition in complex post-operative periods]. / Nutrición parenteral precoz en postoperatorios complejos.

OBJECTIVE: The protein hypercatabolic state in critically ill pediatric patients can be minimized by an effective nutrition therapy. We conducted a study to evaluate the benefits of early parenteral nutrition (EPN) assessing its effect on nutritional parameters and clinical relevance after complex surgical procedures. METHODS: Prospective randomized study in patients undergoing abdominal surgery in which nothing by mouth is anticipated for a period ≥ 3 days, between 2012 and 2014. Blood tests were performed assessing nutritional parameters in the first 24 hours and the 5th postoperative day. Two groups were created, starting EPN in group A and standard fluid therapy in group B, after the extraction of the first sample. RESULTS: Forty-four patients were included, 18 in group A and 26 in group B. In the first analysis all had decreased levels of prealbumin and retinol-binding protein. On the 5th day, 55,6% of group A normalized prealbumin levels compared to 11,5% of B (p: 0.003, EF = 80%) whereas retinol-binding protein was normalized in 66,7% and 34.6%, respectively (p: 0,07, EF = 48,4%). Three patients in group A (16,7%) had postoperative infectious complications compared to 8 in B (30,8%), difference no statistically significant but clinically relevant (NNT=7,1), since the latter showed low prealbumin levels and longer hospital stay. No complications related to EPN were detected. CONCLUSION: Administration of EPN in the complex postoperative patients appears to be safe and beneficial for their recovery, being the prealbumin an early indicator of good nutritional response.

OBJETIVOS: El estado hipercatabólico proteico en el paciente pediátrico postoperado puede ser minimizado con un tratamiento nutricional eficaz. Realizamos un estudio para evaluar los beneficios de la nutrición parenteral precoz (NPp) valorando su efecto sobre los parámetros nutricionales y su relevancia clínica en postoperatorios quirúrgicos complejos. MATERIAL Y METODO: Estudio prospectivo aleatorizado en pacientes sometidos a cirugía abdominal donde se preveía dieta absoluta por un periodo ≥3 días, entre 2012 y 2016. Se realizaron analíticas valorando parámetros nutricionales en las primeras 24 horas y al 5º día postoperatorio. Se crearon 2 grupos, iniciando NPp en grupo A y fluidoterapia estándar en grupo B, tras la extracción de la primera muestra. RESULTADOS: Se incluyeron 44 pacientes, 18 en grupo A y 26 en grupo B. En la primera analítica todos presentaban niveles disminuidos de prealbúmina y proteína fijadora del retinol. Al 5º día, el 55,6% del grupo A normalizaron la prealbúmina frente al 11,5% del B (p: 0,003, FEE = 80%) mientras que la proteína fijadora del retinol se normalizó en el 66,7% y 34,6%, respectivamente (p: 0,07 FEE = 48,4%). Tres pacientes del grupo A (16,7%) presentaron complicaciones infecciosas en el postoperatorio frente a 8 del B (30,8%), diferencia no estadísticamente significativa pero relevante clínicamente (NNT = 7,1), ya que estos últimos mostraban niveles bajos de prealbúmina y mayor estancia hospitalaria. No se detectaron complicaciones relacionadas con la NPp. CONCLUSION: La administración de NPp en postoperatorios complejos parece ser segura y beneficiosa para la recuperación de los pacientes, siendo la prealbúmina un indicador precoz de buena respuesta nutricional.

[Effectiveness analysis of a therapeutic strategy for pediatric varicocele. Have we got what we expected?]. / Análisis de efectividad de una estrategia terapéutica en el varicocele pediátrico. ¿Hemos alcanzado nuestros objetivos?

OBJECTIVE: Optimal treatment ot vancocele in adolescents remains a topic of discussion. Strides in interventional radiology and laparoscopy have allowed us to implement a multidisciplinary therapeutic protocol that aims to get best of both. We evaluate our results. METHODS: . Retrospective study of pediatric patients treated for varicocele in our hospital under protocol between 2008 and 2013. Once the therapeutic indication is confirmed, through clinical and Doppler ultrasound examination, patients undergo percutaneous retrograde embolization (PRE). We perform laparoscopic varicocelectomy (LV) when the PRE fails, together with lymphatic preservation using blue patent lymphography prior to surgery. RESULTS: . Fifty-five patients with varicocele were treated at a mean age of 13 years old (range 11-16). PRE was performed in 50 patients (90.9%), with a proportion of remission of 80% by ultrasound study 6 months after PRE. Sixteen patients (29.1%) underwent LV five of whom without prior PRE. Lymphography with patent blue was performed in 13 (23.6%), and single-port surgery in 6 patients. The presence of coils of PRE did not hinder subsequent LV. The remission rate after LV was 100% at 6 months follow up. Two postoperative lymphoceles were recorded, none after patent blue lymphography. CONCLUSIONS: . We found in this therapeutic sequence a safe and efficient alternative, allowing a minimal surgical invasion and reducing the rate of postoperative lymphoceles.

Characterization and treatment of enuresis in overactive bladder patients. / Caracterización y tratamiento de la enuresis en pacientes con vejiga hiperactiva.

OBJECTIVE: To define the types of overactive bladder (OAB) patient enuresis and study daytime bladder treatment response. MATERIALS AND METHODS: A prospective, multi-center study of OAB patients with enuresis treated with anticholinergics or neuromodulation over 3 months from 2019 to 2021 was carried out. Variables achieved from the voiding calendar and PLUTSS (Pediatric Lower Urinary Tract Score System), as well as enuresis-related variables, were collected. Two study groups were created -primary enuresis (PE) and secondary enuresis (SE). Partial enuretic response (PER) was defined as a > 50% reduction in baseline enuresis, and complete enuretic response (CER) as a 100% reduction. A multivariate analysis was eventually conducted to detect CER independent predictive factors. RESULTS: 152 OAB patients were included. 109 of them (71.7%) had enuresis -29 (26.7%) SE and 80 (73.3%) PE. PLUTSS score was higher in PE patients than in SE patients (20.8 vs. 17.2; p= 0.001). PER and CER were significantly higher in the SE group (55.2% vs. 15%; p= 0.000 in PER, and 48.3% vs. 5%; p= 0.000 in CER). In the multivariate analysis, SE patients demonstrated to have a 50-fold increased probability of responding to daytime bladder treatment than PE patients (OR: 49.79; 95%CI: 6.73-36.8). CONCLUSIONS: Most OAB children have PE and not SE, which explains why enuresis does not typically respond to daytime bladder treatment. Characterizing the type of enuresis in OAB children is important to adequately approach treatment.

OBJETIVOS: Definir los tipos de enuresis de los pacientes con vejiga hiperactiva (VH) y estudiar su respuesta al tratamiento vesical diurno. MATERIAL Y METODOS: Estudio prospectivo y multicéntrico: pacientes con VH y enuresis, tratados con anticolinérgicos o neuromodulación durante 3 meses (2019-2021). Recogimos variables obtenidas del calendario miccional, cuestionario PLUTSS (Pediatric Lower Urinary Tract Score System), y relacionadas con la enuresis. Generamos 2 grupos de estudio: enuresis primaria (EP) y enuresis secundaria (ES). Consideramos respuesta parcial enurética (RPE) a la reducción del valor de enuresis inicial en más de un 50% y respuesta completa (RCE) el 100%. Finalmente realizamos un análisis multivariante para detectar factores predictivos independientes de RCE. RESULTADOS: Incluimos 152 pacientes con VH, 109 de los cuales presentaban enuresis (71,7%): 29 ES (26,7%) y 80 EP (73,3%). El valor PLUTSS fue mayor en pacientes con EP que en ES (20,8 vs. 17,2, p= 0,001.) La RPE y la RCE fueron significativamente mayores en el grupo de ES (55,2% vs. 15%, p= 0,000 en RPE y 48,3% vs. 5%, p= 0,000 en RCE). En el análisis multivariante se identificó que los pacientes con ES tienen una probabilidad de responder al tratamiento vesical diurno 50 veces superior que los pacientes con EP (OR 49,79, IC95% 6,73-36,8). CONCLUSIONES: La mayoría de niños con VH tienen una EP y no secundaria, por lo que generalmente la enuresis de estos pacientes no responde al tratamiento vesical diurno. Es importante caracterizar el tipo de enuresis de los niños con VH para plantear su tratamiento de forma adecuada.

Efficacy of sacral transcutaneous electrical nerve stimulation in patients with overactive bladder refractory to anticholinergic treatment: a prospective multi-center study. / Eficacia de la electroestimulación transcutánea sacra en pacientes con vejiga hiperactiva refractarios a fármacos anticolinérgicos. Estudio prospectivo y multicéntrico.

OBJECTIVE: To determine whether sacral transcutaneous electrical nerve stimulation (S-TENS) is an effective treatment in patients refractory to anticholinergic drugs (Achs). MATERIALS AND METHODS: A prospective multi-center study of patients with overactive bladder (OB) refractory to Achs treated with S-TENS from 2018 to 2021 was carried out. S-TENS was applied over 3 months. Symptom progression was assessed using the voiding calendar and the Pediatric Lower Urinary Tract Symptoms Score (PLUTSS), excluding questions 3 and 4 -referring to enuresis- so that progression of daytime symptoms only (LUTS variable) was analyzed. RESULTS: 66 patients -50% of whom were female- were included, with a mean age of 9.5 years (range: 5-15). S-TENS significantly lowered PLUTSS (19.1 baseline vs. 9.5 final, p< 0.001) and LUTS (13.1 baseline vs. 4.8 final, p< 0.001). It also reduced the number of mictions (8.5 baseline vs. 6.4 final, p< 0.001), while increasing urine volume in the voiding records (214 ml baseline vs. 258 ml final, p< 0.001). Enuresis was the only variable refractory to S-TENS. Complication rate was 3% (2 patients with dermatitis in the S-TENS application area). CONCLUSIONS: S-TENS is effective and safe in the short-term in patients with OB refractory to Achs. Further studies assessing long-term efficacy and potential relapses are required.

OBJETIVOS: Determinar si la electroterapia nerviosa transcutánea a nivel sacro (TENS-S) es un tratamiento efectivo en pacientes refractarios a fármacos anticolinérgicos (Ach). MATERIAL Y METODOS: Estudio prospectivo y multicéntrico: pacientes con VH refractaria a Ach tratados con TENS-S entre 2018-2021. El TENS-S se aplicó durante 3 meses. La evolución sintomática fue evaluada utilizando el calendario miccional y el cuestionario PLUTSS (Pediatric Lower Urinary Tract Symptoms Score), pero excluyendo sus preguntas 3 y 4 (referidas a la enuresis) para analizar solamente la evolución de la sintomatología diurna (variable LUTS). RESULTADOS: Fueron incluidos 66 pacientes (50% niñas), con una edad media de 9,5 años (rango: 5-15). El TENS-S disminuyó significativamente el PLUTSS (19,1 inicial vs 9,5 final, p< 0,001) y el LUTS (13,1 inicial vs 4,8 final, p< 0,001). Además, redujo el número de micciones (8,5 inicial vs 6,4 final, p< 0,001) y aumentó el volumen de orina en los registros miccionales (214 ml inicial vs 258 ml final, p< 0,001). La enuresis fue la única variable refractaria al TENS-S. La tasa de complicaciones fue del 3% (2 pacientes, dermatitis en el área de aplicación del TENS-S). CONCLUSIONES: El TENS-S es efectivo y seguro a corto plazo en pacientes con VH refractarios a los Ach. Deben realizarse estudios para evaluar la eficacia a largo plazo y posibles recaídas.

[Single port video-assisted transumbilical appendectomy. What have we gained and what have we lost after 754 cases]. / Apendicectomía videoasistida transumbilical por puerto único. Qué hemos ganado y qué hemos perdido después de 754 casos.

INTRODUCTION: Single-port transumbilical laparoscopically assisted appendectomy (TULAA) has become the preferred method of treating appendicitis in our Department. At first, it was reserved for noncomplicated cases, and gradually for the rest of them. We have gained experience, and it is time to share it, evaluate the results and raise into new possibilities. MATERIAL AND METHODS: We performed a retrospective statistical analysis of undergone changes over the last years, referring to aspects such as surgical indications, andpostoperative complications, hospital stays and re-admissions. RESULTS: From September 2003 to January 2012, a total of 1,022 appendectomies were performed. Eight hundred and forty-one children underwent TULAA, 89.65% were completed with no problems. In 179 patients, open appendectomy was initially chosen. In those cases, the reasons were complicated appendicitis, obesity or surgeon's preference (43 in the first year and just 3 in the last one). Ninety seven patients had postoperative complications of any kind, fifteen were readmitted to the hospital and 3 were reoperated because of intestinal obstruction. Medical cost savings were estimated around 750.000 Euros. CONCLUSIONS: We think that TULAA is a simple and easy learning procedure, which does not result in any increase in complications, inexpensive and beneficial for patients. However, along these years, our surgical staff may have lost skills and training opportunities in conventional laparoscopic surgery. So although TULAA is still our preferred method in appendicectomy, selected cases will undergo laparoscopic appendectomy.

Use of magnetic double J stents in pediatric patients. / Uso de los catéteres doble J magnéticos en pacientes pediátricos.

OBJECTIVE: Traditionally, double J stent removal in pediatric patients has required cystoscopy under general anesthesia. Magnetic stents allow for double J stent removal without the need for anesthesia. This work describes our initial experience with these stents. MATERIAL AND METHODS: A prospective cohort study of patients under 14 years of age carrying magnetic double J stents from 2018 to 2021 was performed. Variables assessed included baseline diagnosis, surgical procedure, placement success rate, complications associated with use, and need for general anesthesia at removal. RESULTS: 23 stents (4.8 Fr, 15 cm-20 cm) were placed in 21 patients, 62% of whom were male. Mean age was 5.01 years (3 months-13 years). Indications for placement included Anderson-Hynes dismembered pyeloplasty (34.8%), endoscopic dilatation of the ureteropelvic junction (UPJ) (21.8%), cystoscopic dilatation of the ureterovesical junction (UVJ) (17.4%), endoscopic lithotripsy (13.1%), renal trauma (4.3%), suspected retroiliac ureter (4.3%), and cystoscopic drainage of pyonephrosis (4.3%). Mean time of stent use was 4.2 weeks. 3 complications (13%) associated with the double J stent - 1 urinary tract infection (UTI), 1 stent obstruction, and 1 distal stent migration - were recorded. 95.5% of magnetic stents were successfully removed without anesthesia. CONCLUSIONS: Magnetic double J stents can be regarded as an effective alternative to conventional double J stents, since they avoid an additional surgical procedure with general anesthesia in pediatric patients.

OBJETIVOS: Tradicionalmente los catéteres doble J precisan de cistoscopia bajo anestesia general para su retirada en pacientes pediátricos. Los catéteres imantados permiten la retirada del doble J sin necesidad de anestesia. Mediante este trabajo describimos nuestra experiencia inicial con dichos catéteres. MATERIAL Y METODOS: Se ha realizado un estudio de cohorte prospectivo, de pacientes menores de 14 años portadores de doble J imantado desde 2018 a 2021. Las variables estudiadas han sido el diagnóstico inicial, el procedimiento quirúrgico realizado, la tasa de éxito en la colocación, las complicaciones derivadas de su uso y la necesidad de anestesia general en la retirada. RESULTADOS: Se han colocado 23 catéteres (4,8 Fr, 15-20 cm) en 21 pacientes, media de edad de 5,01 años (3 meses-13 años), el 62% varones. Las indicaciones para la colocación han sido: 34,8% tras pieloplastia desmembrada Anderson-Hynes, 21,8% tras dilataciones endoscópicas de la unión pielo-ureteral (UPU), 17,4% tras dilataciones cistoscópicas de la unión uretero-vesical (UUV), 13,1% tras litotricia endoscópica, 4,3% tras traumatismo renal, 4,3% sospecha de uréter retroilíaco y 4,3% tras drenaje cistoscópico de pionefrosis. La media de tiempo de uso de los catéteres ha sido de 4,2 semanas. Registramos tres complicaciones (13%) relacionadas con el doble J: una infección del tracto urinario (ITU), una obstrucción del catéter y una migración distal del catéter. El 95,5% de los imantados se retiraron con éxito sin anestesia. CONCLUSIONES: El doble J magnético puede considerarse una alternativa eficaz a los doble J clásicos, que puede evitar un procedimiento extra con anestesia general en los pacientes pediátricos.

[Are we correctly treating pilonidal disease in children? therapeutic goals beyond preventing recurrence]. / Estamos tratando bien la enfermedad pilonidal en los niños? Objetivos terapéuticos más allá de prevenir la recidiva.

INTRODUCTION: We present a retrospective study of our paediatric patients affected by pilonidal disease over the last 5 years. PATIENTS AND METHOD: In all cases a broad excision of the pilonidal tissue was made, without colour signing the different incision sites and primary closure of the defect with no drainage. RESULTS: Using this technique we treated 20 adolescents (15 girls and 5 boys) of ages between 12 and 15 years (average age 13.3 years) and body mass index between 17 and 33 (mean BMI 26.4 kg/m2). Mean hospitalisation time was 1.45 days. Preoperative antibiotherapy with Amoxicillin-clavulanic was administered to 55% of patients and continued over the first postoperative week. We had four cases with recurrence of the disease (25%) (two of these with two recurrences), which we treated with three primary closures on the midline and three by flattening the cleft. In 2 cases with dehiscence of the wound we allowed treatment by secondary intention. No flaps or marsupialisation were attempted in any case. In all cases the result was aesthetically satisfactory, with maintenance of the intergluteal fold. CONCLUSIONS: In our series we have succeeded in undertaking primary closure of the defect after pilonidal resection without any excessive tension. This treatment enables a rapid return to a normal routine. We considered it important to undertake surgery that maintained the intergluteal fold, especially in patients with a short-term evolution of the disease, reserving flattening the cleft, closure by secondary intention, or primary closure by inserting flaps only for cases of recurrent disease; those with long-term evolution; or patients with complex lesions prior to surgery. Nutritional support to reduce overweight is very important in many patients.

Caracterización y tratamiento de la enuresis en pacientes con vejiga hiperactiva / Characterization and treatment of enuresis in overactive bladder patients

Objetivos: Definir los tipos de enuresis de los pacientes con vejiga hiperactiva (VH) y estudiar su respuesta al tratamiento vesical diurno. Material y métodos. Estudio prospectivo y multicéntrico: pacientes con VH y enuresis, tratados con anticolinérgicos o neuromodulación durante 3 meses (2019-2021). Recogimos variables obtenidas del calendario miccional, cuestionario PLUTSS (Pediatric Lower Urinary Tract Score System), y relacionadas con la enuresis. Generamos 2 grupos de estudio: enuresis primaria (EP) y enuresis secundaria (ES). Consideramos respuesta parcial enurética (RPE) a la reducción del valor de enuresis inicial en más de un 50% y respuesta completa (RCE) el 100%. Finalmente realizamos un análisis multivariante para detectar factores predictivos independientes de RCE. Resultados. Incluimos 152 pacientes con VH, 109 de los cuales presentaban enuresis (71,7%): 29 ES (26,7%) y 80 EP (73,3%). El valor PLUTSS fue mayor en pacientes con EP que en ES (20,8 vs. 17,2, p= 0,001.) La RPE y la RCE fueron significativamente mayores en el grupo de ES (55,2% vs. 15%, p= 0,000 en RPE y 48,3% vs. 5%, p= 0,000 en RCE). En el análisis multivariante se identificó que los pacientes con ES tienen una probabilidad de responder al tratamiento vesical diurno 50 veces superior que los pacientes con EP (OR 49,79, IC95% 6,73-36,8). Conclusiones. La mayoría de niños con VH tienen una EP y no secundaria, por lo que generalmente la enuresis de estos pacientes no responde al tratamiento vesical diurno. Es importante caracterizar el tipo de enuresis de los niños con VH para plantear su tratamiento de forma adecuada.(AU)

Objective: To define the types of overactive bladder (OAB) patient enuresis and study daytime bladder treatment response. Materials and methods. A prospective, multi-center study of OAB patients with enuresis treated with anticholinergics or neuromodulation over 3 months from 2019 to 2021 was carried out. Variables achieved from the voiding calendar and PLUTSS (Pediatric Lower Urinary Tract Score System), as well as enuresis-related variables, were collected. Two study groups were created – primary enuresis (PE) and secondary enuresis (SE). Partial enuretic response (PER) was defined as a >50% reduction in baseline enuresis, and complete enuretic response (CER) as a 100% reduction. A multivariate analysis was eventually conducted to detect CER independent predictive factors. Results. 152 OAB patients were included. 109 of them (71.7%) had enuresis – 29 (26.7%) SE and 80 (73.3%) PE. PLUTSS score was higher in PE patients than in SE patients (20.8 vs. 17.2; p= 0.001). PER and CER were significantly higher in the SE group (55.2% vs. 15%; p= 0.000 in PER, and 48.3% vs. 5%; p= 0.000 in CER). In the multivariate analysis, SE patients demonstrated to have a 50-fold increased probability of responding to daytime bladder treatment than PE patients (OR: 49.79; 95%CI: 6.73-36.8). Conclusions. Most OAB children have PE and not SE, which explains why enuresis does not typically respond to daytime bladder treatment. Characterizing the type of enuresis in OAB children is important to adequately approach treatment.(AU)

Eficacia de la electroestimulación transcutánea sacra en pacientes con vejiga hiperactiva refractarios a fármacos anticolinérgicos. Estudio prospectivo y multicéntrico / Efficacy of sacral transcutaneous electrical nerve stimulation in patients with overactive bladder refractory to anticholinergic treatment: a prospective multi-center study

Objetivos: Determinar si la electroterapia nerviosa transcutánea anivel sacro (TENS-S) es un tratamiento efectivo en pacientes refractariosa fármacos anticolinérgicos (Ach).Material y métodos: Estudio prospectivo y multicéntrico: pacientes con VH refractaria a Ach tratados con TENS-S entre 2018-2021. El TENS-S se aplicó durante 3 meses. La evolución sintomática fueevaluada utilizando el calendario miccional y el cuestionario PLUTSS(Pediatric Lower Urinary Tract Symptoms Score), pero excluyendo suspreguntas 3 y 4 (referidas a la enuresis) para analizar solamente laevolución de la sintomatología diurna (variable LUTS).Resultados: Fueron incluidos 66 pacientes (50% niñas), con unaedad media de 9,5 años (rango: 5-15). El TENS-S disminuyó significativamente el PLUTSS (19,1 inicial vs 9,5 final, p< 0,001) y el LUTS (13,1inicial vs 4,8 final, p< 0,001). Además, redujo el número de micciones(8,5 inicial vs 6,4 final, p< 0,001) y aumentó el volumen de orina enlos registros miccionales (214 ml inicial vs 258 ml final, p< 0,001). Laenuresis fue la única variable refractaria al TENS-S. La tasa de complicaciones fue del 3% (2 pacientes, dermatitis en el área de aplicacióndel TENS-S). Conclusiones: El TENS-S es efectivo y seguro a corto plazo enpacientes con VH refractarios a los Ach. Deben realizarse estudios paraevaluar la eficacia a largo plazo y posibles recaídas.(AU)

Objective: To determine whether sacral transcutaneous electricalnerve stimulation (S-TENS) is an effective treatment in patients refractory to anticholinergic drugs (Achs).Materials and methods. A prospective multi-center study of patients with overactive bladder (OB) refractory to Achs treated with S-TENS from 2018 to 2021 was carried out. S-TENS was applied over 3months. Symptom progression was assessed using the voiding calendarand the Pediatric Lower Urinary Tract Symptoms Score (PLUTSS),excluding questions 3 and 4 –referring to enuresis– so that progressionof daytime symptoms only (LUTS variable) was analyzed. Results: 66 patients –50% of whom were female– were included,with a mean age of 9.5 years (range: 5-15). S-TENS significantly lowered PLUTSS (19.1 baseline vs. 9.5 final, p< 0.001) and LUTS (13.1baseline vs. 4.8 final, p< 0.001). It also reduced the number of mictions(8.5 baseline vs. 6.4 final, p< 0.001), while increasing urine volume inthe voiding records (214 ml baseline vs. 258 ml final, p< 0.001). Enuresiswas the only variable refractory to S-TENS. Complication rate was 3%(2 patients with dermatitis in the S-TENS application area).Conclusions: S-TENS is effective and safe in the short-term inpatients with OB refractory to Achs. Further studies assessing long-termefficacy and potential relapses are required.(AU)

Uso de los catéteres doble J magnéticos en pacientes pediátricos / Use of magnetic double J stents in pediatric patients

Objetivos: Tradicionalmente los catéteres doble J precisan de cistoscopia bajo anestesia general para su retirada en pacientes pediátricos.Los catéteres imantados permiten la retirada del doble J sin necesidadde anestesia. Mediante este trabajo describimos nuestra experienciainicial con dichos catéteres.Material y métodos: Se ha realizado un estudio de cohorte prospectivo, de pacientes < 14 años portadores de doble J imantado desde 2018 a 2021. Las variables estudiadas han sido el diagnóstico inicial, el procedimiento quirúrgico realizado, la tasa de éxito en la colocación, las complicaciones derivadas de su uso y la necesidad de anestesia general en la retirada.Resultados: Se han colocado 23 catéteres (4,8 Fr, 15-20 cm) en 21pacientes, media de edad de 5,01 años (3 meses-13 años), el 62% varo-nes. Las indicaciones para la colocación han sido: 34,8% tras pieloplastiadesmembrada Anderson-Hynes, 21,8% tras dilataciones endoscópicas dela unión pielo-ureteral (UPU), 17,4% tras dilataciones cistoscópicas dela unión uretero-vesical (UUV), 13,1% tras litotricia endoscópica, 4,3%tras traumatismo renal, 4,3% sospecha de uréter retroilíaco y 4,3% trasdrenaje cistoscópico de pionefrosis. La media de tiempo de uso de loscatéteres ha sido de 4,2 semanas. Registramos tres complicaciones (13%)relacionadas con el doble J: una infección del tracto urinario (ITU), unaobstrucción del catéter y una migración distal del catéter. El 95,5% delos imantados se retiraron con éxito sin anestesia.Conclusiones: El doble J magnético puede considerarse una alternativa eficaz a los doble J clásicos, que puede evitar un procedimientoextra con anestesia general en los pacientes pediátricos.

Objective: Traditionally, double J stent removal in pediatric patients has required cystoscopy under general anesthesia. Magnetic stents allowfor double J stent removal without the need for anesthesia. This workdescribes our initial experience with these stents.Materials and methods: A prospective cohort study of patientsunder 14 years of age carry-ing magnetic double J stents from 2018 to2021 was performed. Variables assessed included baseline diagnosis,surgical procedure, placement success rate, complications associatedwith use, and need for general anesthesia at removal.Results: 23 stents (4.8 Fr, 15 cm-20 cm) were placed in 21 patients,62% of whom were male. Mean age was 5.01 years (3 months-13 years).Indications for placement included An-derson-Hynes dismembered py-eloplasty (34.8%), endoscopic dilatation of the ureteropelvic junction(UPJ) (21.8%), cystoscopic dilatation of the ureterovesical junction(UVJ) (17.4%), endoscopic lithotripsy (13.1%), renal trauma (4.3%),suspected retroiliac ureter (4.3%), and cystoscopic drainage of pyone-phrosis (4.3%). Mean time of stent use was 4.2 weeks. 3 com-plications(13%) associated with the double J stent – 1 urinary tract infection (UTI),1 stent obstruction, and 1 distal stent migration – were recorded. 95.5%of magnetic stents were suc-cessfully removed without anesthesia.Conclusions: Magnetic double J stents can be regarded as an effec-tive alternative to conven-tional double J stents, since they avoid an ad-ditional surgical procedure with general anesthe-sia in pediatric patients.

[Slipping rib syndrome. An aggressive but effective treatment]. / Síndrome de la costilla deslizante. Tratamiento agresivo pero eficaz.

Slipping rib syndrome (SRS) is an unusual cause of recurrent chest or abdominal pain in children. The diagnosis is elusive, including gastroenterological, cardiac, respiratory, infectious and chest or abdominal muscular pathologies. Two paediatric patients were diagnosed with SRS, both of them were female teenagers with a similar clinical pattern: crippling unilateral chest pain without a traumatic event. On physical examination, all patients had reproducible pain with the "hooking maneuver". Surgical excision of the costal cartilages was done, preserving the perichondrium. No complications were reported. In both cases we achieve an excellent outcome after one and four years of follow-up, resolving the symptoms completely. The surgical excision of the costal cartilages seems to be an aggressive option but with an excellent outcome. A minimum invasive approach could be a better option in the future.

[Pheochromocytoma and paraganglioma in childhood: a report of 2 cases report]. / Feocromocitoma y paraganglioma en la infancia: a propósito de 2 casos.

Pheochromocytomas and paragangliomas are rare neuroendocrine tumors in children and most of them are sporadic. However, they represent the most common endocrine tumor in childhood, and hereditary tumor syndromes are most relevant in these age. Advances in genetic, biochemistry and imaging techniques have revised the management of these tumors; thus A biochemical study should be always initiated once the clinical diagnosis is suspected, followed by imaging and molecular studies, particularly in the context of known familial disease. The diagnostic and therapeutic features are reviewed after the presentation of two clinical cases, where the second one is a patient with type 1 Neurofibromatosis.

[Sinus pericranii. A series of 5 cases]. / Sinus pericranii. Serie de 5 casos.

Sinus pericranii is a rare vascular anomaly in which an abnormal communication exists between the extracranial venous system and the dural venous sinuses. The natural history in most cases consists of a purplish nodule in the frontal region that may gradually increase in size. Different treatment options can be chosen: from observation of the lesion, to endovascular embolization of intracerebral component or a complete resection of both anomalous components (extra- and intra-cranial) by surgery. In this context, potential life-threatening complications including thrombosis and cerebral hemorrhage can occur. Here we present our experience in management of sinus pericranii, and emphasize the importance of a multidisciplinary therapeutic approach of this uncommon entity.

Reparación laparoscópica de la hernia inguinal e hidrocele en edad pediátrica. Nuestra experiencia en los últimos años / No disponible

Objetivos: La reparación laparoscópica de la hernia inguinal e hidroceles en la edad pediátrica, se ha convertido en una alternativa a la herniorrafia inguinal clásica. Describimos nuestra experiencia en las intervenciones realizadas con dicha técnica. Material y métodos: Estudio retrospectivo de las reparaciones laparoscópicas de hernia inguinal e hidrocele realizadas en el periodo 2003-2016. Se han incluido pacientes < 14 años, diagnosticados de hidrocele comunicante y/o de hernia inguinal indirecta (N=39), divididos en dos cohortes: grupo A pacientes con hernia inguinal indirecta y grupo B pacientes con hidrocele comunicante. Se ha empleado el abordaje laparoscópico intraperitoneal, y anillorrafia del orificio inguinal interno sin resección del saco herniario. Las variables principales estudiadas han sido la indicación quirúrgica y las complicaciones postquirúrgicas. Resultados: Las indicaciones quirúrgicas han sido los defectos bilaterales (46,2%), defectos unilaterales (28,2%), defectos asociados a hernia umbilical (23,1%) y asociados a otra patología (2,6%). En el grupo A la tasa de complicaciones que precisaron de ingreso fue de 3,2% y la tasa de recurrencias fue de 9,7%; mientras que en el B han sido del 12,5% y del 12,5% respectivamente. No hay una relación significativa respecto a la edad, la lateralidad o la sutura utilizada y la tasa de complicaciones en ninguno de los grupos. Conclusiones: A pesar de las limitaciones del estudio, el porcentaje total de complicaciones (15,3%) es más elevado que el publicado en la literatura. Esto nos hace reflexionar y no olvidar que el abordaje laparoscópico no es una técnica exenta de riesgos y requiere de una curva de aprendizaje

Introduction: Laparoscopic inguinal hernia and hydrocele repair has become an alternative to the more frequently used inguinal approach. We describe our experience with the laparoscopic technique. Material and methods: Retrospective study of laparoscopic inguinal hernia and hydrocele repair performed during the period between 20032016. We included patients <14 years, with communicating hydrocele and / or indirect inguinal hernia diagnosis (N = 39). We have studied two cohorts; group A patients with indirect inguinal hernia (N = 31) and group B patients with communicating hydrocele (N = 8). We used intraperitoneal laparoscopic approach, performing herniorrhaphy of the internal inguinal orifice without resection of the hernial sac. The main outcome measurements were surgical indication and postoperative complications. Results: The indication for laparoscopic repair was bilateral defects (46.2%), unilateral defects (28.2%), defects associated with umbilical hernia (23.1%) and associated with another pathology (2.6%). In group A the rate of complications that required new admission was 3.2% and the recurrence rate was 9.7%. In group B, was 12.5% and 12.5% respectively. We have not observed a significant relationship with respect to patient age, laterality or suture used and the rate of complications in any of the groups. Conclusions: Despite the limitations of our study given the small sample size and retrospective nature, the complication rate (15%) is higher than that published in the literature. This makes us take a step back to reassess our indications and technique, and not forget that the laparoscopic approach is not a technique without risks and requires a learning curve

Nutrición parenteral precoz en postoperatorios complejos / Early parenteral nutrition in complex post-operative periods

Objetivo. El estado hipercatabólico proteico en el paciente pediátrico postoperado puede ser minimizado con un tratamiento nutricional eficaz. Realizamos un estudio para evaluar los beneficios de la nutrición parenteral precoz (NPp) valorando su efecto sobre los parámetros nutricionales y su relevancia clínica en postoperatorios quirúrgicos complejos. Material y método. Estudio prospectivo aleatorizado en pacientes sometidos a cirugía abdominal donde se preveía dieta absoluta por un periodo ≥3 días, entre 2012 y 2016. Se realizaron analíticas valorando parámetros nutricionales en las primeras 24 horas y al 5º día postoperatorio. Se crearon 2 grupos, iniciando NPp en grupo A y fluidoterapia estándar en grupo B, tras la extracción de la primera muestra. Resultados. Se incluyeron 44 pacientes, 18 en grupo A y 26 en grupo B. En la primera analítica todos presentaban niveles disminuidos de prealbúmina y proteína fijadora del retinol. Al 5º día, el 55,6% del grupo A normalizaron la prealbúmina frente al 11,5% del B (p: 0,003, FEE = 80%) mientras que la proteína fijadora del retinol se normalizó en el 66,7% y 34,6%, respectivamente (p: 0,07 FEE = 48,4%). Tres pacientes del grupo A (16,7%) presentaron complicaciones infecciosas en el postoperatorio frente a 8 del B (30,8%), diferencia no estadísticamente significativa pero relevante clínicamente (NNT = 7,1), ya que estos últimos mostraban niveles bajos de prealbúmina y mayor estancia hospitalaria. No se detectaron complicaciones relacionadas con la NPp. Conclusión. La administración de NPp en postoperatorios complejos parece ser segura y beneficiosa para la recuperación de los pacientes, siendo la prealbúmina un indicador precoz de buena respuesta nutricional

Objective. The protein hypercatabolic state in critically ill pediatric patients can be minimized by an effective nutrition therapy. We conducted a study to evaluate the benefits of early parenteral nutrition (EPN) assessing its effect on nutritional parameters and clinical relevance after complex surgical procedures. Methods. Prospective randomized study in patients undergoing abdominal surgery in which nothing by mouth is anticipated for a period ≥ 3 days, between 2012 and 2014. Blood tests were performed assessing nutritional parameters in the first 24 hours and the 5th postoperative day. Two groups were created, starting EPN in group A and standard fluid therapy in group B, after the extraction of the first sample. Results: Forty-four patients were included, 18 in group A and 26 in group B. In the first analysis all had decreased levels of prealbumin and retinol-binding protein. On the 5th day, 55,6% of group A normalized prealbumin levels compared to 11,5% of B (p: 0.003, EF = 80%) whereas retinol-binding protein was normalized in 66,7% and 34.6%, respectively (p: 0,07, EF = 48,4%). Three patients in group A (16,7%) had postoperative infectious complications compared to 8 in B (30,8%), difference no statistically significant but clinically relevant (NNT=7,1), since the latter showed low prealbumin levels and longer hospital stay. No complications related to EPN were detected. Conclusion. Administration of EPN in the complex postoperative patients appears to be safe and beneficial for their recovery, being the prealbumin an early indicator of good nutritional response

Síndrome de la costilla deslizante. Tratamiento agresivo pero eficaz / Slipping rib syndrome. An aggressive but effective treatment

El síndrome de la costilla deslizante (SCD) es una entidad infrecuente, que exige un diagnóstico diferencial preciso incluyendo patología digestiva, cardiaca, respiratoria, infecciosa y músculo-esquelética torácica o abdominal. Se presenta el caso de dos niñas, en edad puberal, con dolor torácico incapacitante de varios meses de evolución y sin antecedente traumático. En la exploración existía un punto de dolor a la palpación de la parrilla costal y la 'maniobra del gancho' era dolorosa. Se realizó una resección de los cartílagos costales, respetando el pericondrio. La evolución tras uno y cuatro años de seguimiento, fue satisfactoria sin complicaciones y con resolución inmediata de la sintomatología. La cirugía de resección costal parece una opción muy agresiva, aunque con resultados muy satisfactorios. Un abordaje mínimamente invasivo podría ser mejor opción a considerar en el futuro (AU)

Slipping rib syndrome (SRS) is an unusual cause of recurrent chest or abdominal pain in children. The diagnosis is elusive, including gastroenterological, cardiac, respiratory, infectious and chest or abdominal muscular pathologies. Two paediatric patients were diagnosed with SRS, both of them were female teenagers with a similar clinical pattern: crippling unilateral chest pain without a traumatic event. On physical examination, all patients had reproducible pain with the 'hooking maneuver'. Surgical excision of the costal cartilages was done, preserving the perichondrium. No complications were reported. In both cases we achieve an excellent outcome after one and four years of follow-up, resolving the symptoms completely. The surgical excision of the costal cartilages seems to be an aggressive option but with an excellent outcome. A minimum invasive approach could be a better option in the future (AU)

Feocromocitoma y paraganglioma en la infancia: a propósito de 2 casos / Pheochromocytoma and paraganglioma in childhood: A report of 2 cases report

Los feocromocitomas y los paragangliomas son tumores neuroendocrinos infrecuentes en pediatría; sin embargo, estos representan el tumor endocrino más frecuente en la infancia. La mayoría son esporádicos, cobrando mayor relevancia los síndromes familiares en edad pediátrica. Los avances en el campo de la genética, en bioquímica y en técnicas de imagen han adaptado el manejo de estos tumores; de modo que el estudio bioquímico debe comenzarse ante todo diagnóstico clínico de sospecha, seguido del estudio por imagen y molecular, más aún ante la existencia de un síndrome familiar conocido. Revisamos aspectos clínicos, diagnósticos y terapéuticos a propósito de 2 casos, presentando el segundo paciente antecedentes de neurofibromatosis tipo 1

Pheochromocytomas and paragangliomas are rare neuroendocrine tumors in children and most of them are sporadic. However, they represent the most common endocrine tumor in childhood, and hereditary tumor syndromes are most relevant in these age. Advances in genetic, biochemistry and imaging techniques have revised the management of these tumors; thus A biochemical study should be always initiated once the clinical diagnosis is suspected, followed by imaging and molecular studies, particularly in the context of known familial disease. The diagnostic and therapeutic features are reviewed after the presentation of two clinicalcases, where the second one is a patient with type 1 Neurofibromatosis

Quistes neuroentéricos, una causa infrecuente de hemorragia intestinal / Neurenteric cysts; an uncommon cause of intestinal bleeding

No disponible