[Is there a difference in the postoperative follow up of ureteropelvic junction obstruction according to age?] / ¿Existe diferencia en la evolución postoperatoria de la estenosis pieloureteral según la edad?

OBJECTIVE: To compare postoperative follow up in patients older and younger than 12 months who underwent surgical treatment of ureteropelvic junction obstruction (UJO). MATERIAL AND METHODS: Retrospective study of 77 patients, 78 kidney units, intervened from UJO (2007-2014). We analyzed epidemiological, clinical, echographic, and pre and postoperative renogram variables, outcomes and complications. We divided the patients into 2 groups according to age: group A ≤ 12 months and group B > 12 months, comparing the results by statistical analysis, considering p < 0.05 statistically significant. RESULTS: Group A: 38 patients, 26 males (68.4%), one bilateral UJO and 22 rights (57.9%), 36 prenatal diagnoses (92.3%) and mean age of intervention 5.28 months [range 0.24 -11,28]. We performed 9 minilumbotomies, 29 assisted by retroperitoneoscopy (ARP) and 1 pneumatic dilation (PD). Group B: 39 patients, 26 males (66.7%), 10 rights (25.64%), 19 prenatal diagnoses (48.7%) and mean age 6.13 years [range 1.13-14.52]. 15 minilumbotomies, 20 ARP, 3 laparoscopic and 1 PD. Preoperative mean renal function (MRF) of group A: 35.9 ± 13.4 [range 8-57] vs. 39.74 ± 13.91 [range 9-57] in group B (p = 0.347). Postoperative MRF 43.29 ± 18.2 [range 12-100] group A and 39.41 ± 12.89 [range 11-54] group B (p = 0.464). Group A and B: 11 and 8 complications, respectively (p = 0.429). We did not find statistically significant differences in the mean preoperative anteroposterior diameter (DAP) between both groups (p = 0.313). We compared DAP at 3, 6, 12, 24 and 48 postoperative months, observing a greater reduction of DAP from group A compared to B; however, we found only statistically significant differences in DAP at 3 months postoperatively (p = 0.047). CONCLUSION: Renal DAP is reduced postoperatively more in patients younger than 1 year. Moreover, an improvement of the DRF after pieloplasty can be observed despite not being statistically significant.

OBJETIVO: Comparar la evolución postquirúrgica en pacientes mayores y menores de 12 meses intervenidos de estenosis pieloureteral (EPU). MATERIAL Y METODOS: Estudio retrospectivo de 77 pacientes, 78 unidades renales, intervenidos por EPU (2007-2014). Analizamos variables epidemiológicas, clínicas, ecográficas y de renogramas pre y postoperatorios, resultados y complicaciones. Dividimos a los pacientes en 2 grupos según la edad: grupo A ≤ 12 meses y grupo B > 12 meses, comparando los resultados mediante análisis estadísticos (p < 0,05 estadísticamente significativo). RESULTADOS: Grupo A: 38 pacientes, 26 varones (68,4%), una EPU bilateral y 22 derechas (57,9%), 36 diagnósticos prenatales (92,3%) y edad media de intervención 5,28 meses [rango 0,24-11,28]. Realizamos 9 minilumbotomías, 29 asistidas por retroperitoneoscopia (ARP) y una dilatación neumática (DN). Grupo B: 39 pacientes, 26 varones (66,7%), 10 derechas (25,64%), 19 diagnósticos prenatales (48,7%) y edad media 6,13 años [rango 1,13-14,52]. Realizamos 15 minilumbotomías, 20 ARP, 3 laparoscópicas y 1 DN. Función renal diferencial media (FRDM) preoperatoria del grupo A: 35,9 ± 13,4 [rango 8-57] vs. 39,74 ± 13,91 [rango 9-57] grupo B (p = 0,347). FRDM postoperatoria 43,29 ± 18,2 [rango 12-100] grupo A y 39,41 ± 12,89 [rango 11-54] grupo B (p = 0,464). Grupos A y B: 11 y 8 complicaciones, respectivamente (p = 0,429). No encontramos diferencias estadísticamente significativas en la media del diámetro anteroposterior (DAP) de la pelvis preoperatoria entre ambos grupos (p = 0,313). Comparamos los DAP a los 3, 6, 12, 24 y 48 meses postoperatorios, observando una reducción mayor del DAP del grupo A frente al B, sin embargo, solo encontramos diferencias estadísticamente significativas en el DAP a los 3 meses postoperatorios (p = 0,047). CONCLUSION: El DAP de la pelvis renal se reduce más en los pacientes menores de 1 año a los 3 meses postoperatorios. Además, podemos observar una evidente mejoría de la FRDM tras la pieloplastia a pesar de no encontrar diferencias estadísticamente significativas.

[Psychoprophylaxis in elective paediatric general surgery: does audiovisual tools improve the perioperative anxiety in children and their families?] / Psicoprofilaxis quirurgica audiovisual en cirugía general pediátrica: ¿podemos disminuir la ansiedad del niño y de su familia?

AIM OF THE STUDY: Surgery is considered a stressful experience for children and their families who undergo elective procedures. Different tools have been developed to improve perioperative anxiety. Our objective is to demonstrate if the audiovisual psychoprophylaxis reduces anxiety linked to paediatric surgery. METHODS: A randomized prospective case-control study was carried out in children aged 4-15 who underwent surgery in a Paediatric Surgery Department. We excluded patients with surgical backgrounds, sever illness or non-elective procedures. Simple randomization was performed and cases watched a video before being admitted, under medical supervision. Trait and state anxiety levels were measured using the STAI-Y2, STAI-Y2, STAI-C tests and VAS in children under 6-years-old, at admission and discharge. RESULTS: 100 patients (50 cases/50 controls) were included, mean age at diagnosis was 7.98 and 7.32 respectively. Orchiopexy was the most frequent surgery performed in both groups. Anxiety state levels from parents were lower in the Cases Group (36.06 vs 39.93 p= 0.09 in fathers, 38.78 vs 40.34 p= 0.43 in mothers). At discharge, anxiety levels in children aged > 6 were statistically significant among cases (26.84 vs 32.96, p< 0.05). CONCLUSIONS: The use of audiovisual psychoprophylaxis tools shows a clinically relevant improvement in perioperative anxiety, both in children and their parents. Our results are similar to those reported by other authors supporting these tools as beneficial strategy for the family.

OBJETIVOS: La cirugía supone una experiencia traumática tanto para el niño como para su familia. Recientemente se han diseñado estrategias audiovisuales en nuestro Servicio para tratar de disminuir la ansiedad vinculada a la intervención quirúrgica. Nuestro objetivo es analizar si la psicoprofilaxis audiovisual reduce los niveles de ansiedad derivados del evento quirúrgico. MATERIAL Y METODOS: Estudio prospectivo aleatorizado en niños intervenidos en el Servicio de Cirugía Pediátrica (4-15 años). Se excluyeron pacientes con antecedentes quirúrgicos, patología grave o procedimientos de Urgencia. La aleatorización en casos-controles fue realizada mediante sistema par-impar. Los casos visualizaron el vídeo antes del ingreso bajo supervisión médica. Se realizó la evaluación de los niveles de ansiedad estado y ansiedad rasgo mediante test autocompletables (STAI-Y1,STAI-Y2,STAI-C, test EVA en < 6 años) al ingreso y al alta en ambos grupos. RESULTADOS: 100 pacientes fueron incluidos (50 casos/50 controles) edad media de 7,98 y 7,32 años, respectivamente. La intervención practicada con mayor frecuencia fue la orquidopexia en ambos grupos. Se observaron niveles de ansiedad estado menores en los progenitores de los casos frente a los controles (36,06 vs 39.93 en padres p= 0,09, 38,78 vs 40,34 en madres p= 0,43). Al alta, los niveles de ansiedad fueron menores en niños > 6 años (26,84 vs 32,96), siendo esta diferencia estadísticamente significativa (p< 0,05). CONCLUSIONES: El uso de la psicoprofilaxis prequirúrgica mediante herramientas audiovisuales disminuye la ansiedad de forma clínicamente relevante tanto en los niños como en sus familias de manera sencilla y fácilmente reproducible. Nuestros resultados coinciden con los reportados en la literatura y consideramos esta herramienta beneficiosa para el núcleo familiar.

[Is there an ideal patient for transumbilical laparoscopic assisted appendectomy?] / ¿Existe el paciente ideal para la apendicectomía transumbilical asistida por laparoscopia?

OBJECTIVES: To identify the factors that lead to postoperative morbidity in acute appendicitis patients treated using a TULAA (Transumbilical laparoscopic assisted appendectomy) approach. MATERIAL AND METHODS: Retrospective review of patients treated through a TULAA approach between 2007 and 2014. Data concerning the location of the appendix, need for conversion, appendiceal abscess or perforation, surgical time and other complications were collected. Student's T test and Chi-squared test were used for statistical analysis. RESULTS: A total of 111 appendectomies underwent TULAA. The average operating time was 79 minutes (45-150). Nonperforated appendicitis was found in 90% of patients with 10% having perforated appendicitis or appendiceal abscess. In 35,13% of cases, additional trocars were used, usually when the appendix was in a retrocecal position (89,5%). When the appendix was found in a pelvic or ileal position, a need for extra trocars decreased to 25.9% (p< 0.05). The surgery was converted to open surgery in 6,3% of the cases. The appendix in a retrocecal position had a conversion rate of 20,8% compared to 2,3% of cases with an appendix in a pelvic location (p< 0.05). A total of 3,6% reported postoperative wound infection, possibly caused by perforation of the appendix during extraction (p< 0.05). All the perforated appendixes were considered complicated appendixes. CONCLUSIONS: The retrocecal location of the appendix is associated with the need to install additional trocars or conversion to open surgery. The TULAA approach is ideal for patients with nonperforated acute appendicitis in a pelvic or ileal location.

OBJETIVOS: Identificar los factores que influyen en la morbilidad postoperatoria en pacientes intervenidos mediante apendicectomía transumbilical asistida por laparoscopia o TULAA (transumbilical laparoscopic assisted appendectomy). MATERIAL Y METODOS: Estudio analítico retrospectivo de pacientes intervenidos mediante TULAA en nuestro centro entre 2007-2014. Se incluyeron las variables: localización del apéndice, reconversiones, tipo de apendicitis, tiempo quirúrgico y complicaciones. Se utilizó t de Student y chi-cuadrado para el análisis estadístico. RESULTADOS: Se analizaron un total de 111 apendicectomías TULAA. Tiempo quirúrgico medio 79 minutos (45-150). El 90% de pacientes tenían apendicitis simple y 10% apendicitis complicada. En 35,13% casos se utilizaron trócares adicionales, cuando el apéndice se posicionaba de forma atípica ascendió al 89,5% de casos, mientras que cuando el apéndice se encontró en posición típica este dato disminuía al 25,9% (p< 0,05). Se reconvirtió en un 6,3% de casos (20,8% apéndice en posición atípica, 2,3% apéndice en posición habitual, pp< 0,05). Se encontró un 3,6% de casos con infección de herida quirúrgica explicada por perforación iatrogénica en la maniobra de extracción del apéndice (pp< 0,05). Todas las apéndices perforadas en la maniobra de extracción se trataron de apendicitis complicadas. CONCLUSIONES: La posición anómala del apéndice se relaciona de forma significativa con la necesidad de colocación de trócares adicionales o reconversión a cirugía abierta. Consideramos la TULAA ideal en los casos de localización anterior del apéndice y en apendicitis no complicadas.

[Long-term evolution of detorsion of the testes after acute scrotum]. / Evolución a largo plazo de la detorsión testicular tras escroto agudo.

OBJECTIVES: To assess the long-term evolution of the testicles preserved after testicular torsion (TT). MATERIAL AND METHODS: We realized a prospective study by ultrasound of patients diagnosed TT that underwent orchidopexy. We reviewed 85 patients treated for acute scrotum (2004-2014), finding 49TT. We excluded from the study 15 perinatal torsions, 14 orchiectomies and 5 patients who refused to participate. We analyzed 15 patients, comparing testicular volumes between affected and contralateral testes, and the difference in volume between the two testes of the 15 cases with 14 control patients (Mann-Whitney U test). RESULTS: 15 patients underwent surgery at a mean age of 10,7 years, with an average time of 6 hours evolution [0,7-24]. The control ultrasound was performed at a mean age of 14,7 years, after a mean time of 47 months after the episode, finding a medium volume of the affected and contralateral testicle of 9,3 cc and 12,6 cc, respectively (p = 0,683). The median of the difference between the volumes was 0'8 cc [0,1-12,80]. In the control group, ultrasounds were performed at a mean age of 16 years, with an average volume of 6,64 cc on right testicle and 6,26 cc on the left, and median volume difference of 0,34 cc [0,05-4,59]; with no statistically significant difference (p = 0,270) between testicular volume differences of cases and controls. CONCLUSION: Testicular orchidopexy in patients with TT with less than 6 hours of evolution does not affect the long-term testicular growth, compared with the contralateral testis growth and testes of the normal population.

OBJETIVOS: Valorar la evolución a largo plazo de los testículos preservados tras torsión testicular (TT). MATERIAL Y METODOS: Estudio prospectivo mediante ecografía de pacientes diagnosticados de TT a los que se les realizó detorsión y orquidopexia. Revisamos 85 pacientes intervenidos por escroto agudo (2004-2014), encontrando 49TT. Excluimos del estudio 15 torsiones perinatales, 14 orquiectomías y 5 pacientes que se negaron a participar. Analizamos 15 pacientes, comparando volúmenes testiculares entre testes afectos y contralaterales, y la diferencia de volúmenes entre ambos testes de los 15 casos con 14 pacientes control (prueba U de Mann-Whitney). RESULTADOS: Los 15 pacientes se intervinieron a una edad media de 10,7 años, con un tiempo medio de evolución de 6 horas [0,7-24]. La ecografía control se realizó a una edad media de 14,7 años, tras un tiempo medio de 47 meses después del episodio, encontrando unas medianas del volumen del teste torsionado y contralateral de 9,3 cc y 12,6 cc, respectivamente (p = 0,683). La mediana de la diferencia entre los volúmenes fue de 0,8 cc [0,1-12,80]. En el grupo control, las ecografías fueron realizadas a una edad media de 16 años, con media de volumen de teste izquierdo de 6,26 cc y derecho de 6,64 cc, y mediana de diferencia de volúmenes de 0,34 cc [0,05-4,59]; no encontrándose diferencias estadísticamente significativas (p = 0,270) entre las diferencias de volúmenes de los testículos de casos y controles. CONCLUSION: La detorsión testicular en pacientes con TT con un tiempo de evolución inferior a 6 horas no influye en el crecimiento testicular a largo plazo, comparado con el crecimiento del teste contralateral y de los testículos de la población normal.

[Efficacy of the retroperitoneal-assisted laparoscopic pyeloplasty versus the mini posterior lumbotomy approach]. / Eficacia de la pieloplastia asistida por retroperitoneoscopia versus a la realizada por minilumbotomía posterior.

OBJECTIVE: To evaluate the results of the retroperitoneal-assisted laparoscopic pyeloplasty (RALP) versus the mini posterior lumbotomy pyeloplasty (MPLP). MATERIAL AND METHODS: A retrospective study of 77 patients diagnosed with ureteropelvic junction obstruction between 2007 and 2013 was made, analyzing the surgical technique, complications and results. The anteroposterior pelvic diameter of the kidney, the thickness of the renal parenchyma, the renal function and the morphology of the renogram curve were also evaluated and compared. RESULTS: We performed 50 RALP and 21 MPLP. Median age of intervention: 10.85 moths (ICR 86.8) in RALP and 23.30 moths (ICR 54.7) in MPLP. No significant differences were found in surgical time (p>0.05). Double J was left in 90% of the RALP and 52.4% of the MPLP. Median length of incision was 1.5 cm of the RALP and 3.0cm in MPLP(p<0.05). The Median hospital stay was 2.0 days and 3.0 respectively (p<0.05). We found surgical complications (restenosis and urinoma) in 9 patients of the RALP group and 1 in the mini lumbotomy group (p>0,05). The follow-up was performed using ultrasound in an average of 68,04 months of age (range 7.5-186.5) and diuretic renogram in an average of 50,25 months of age (range 6,6-173,8). The above parameters showed improvements in both groups of patients without significant differences. CONCLUSIONS: In our experience, the RALP is a technique with a greater rate of complications than the expected. Moreover, the MPLP, is a technique we consider safe and with adequate aesthetic and functional results.

OBJETIVO: Evaluar la pieloplastia asistida por retroperitoneoscopia, exteriorizando la unión pieloureteral (PAR) versus la pieloplastia por minilumbotomía posterior en ángulo costovertebral (PMLP). MATERIAL Y METODOS: Estudio retrospectivo de 77 pacientes diagnosticados de estenosis pieloureteral (2007-2013), se analizaron técnica, complicaciones y resultados, mediante la valoración del diámetro anteroposterior de la pelvis renal, grosor del parénquima renal, función renal y morfología de la curva del renograma. RESULTADOS: Realizamos 50 PAR y 21 PMLP. Edad mediana de intervención: 10,85 meses [rango intercuartílico (IC) 86,8] en PAR y 23,3 meses (rango IC 54,7) en PMLP. No hubo diferencias significativas en tiempo quirúrgico. Se dejó doble J en 90% de las PAR y en 52,4% de las PMLP. La incisión fue 1,5 cm en la PAR y 3,0 cm de mediana (rango IC 1,0) en la PMLP (p<0,05). La mediana de estancia fue 2,0 días y 3,0 respectivamente (p<0,05). Encontramos complicaciones (reestenosis y urinomas) en 9 pacientes del grupo PAR y en uno en el grupo de minilumbotomía (p>0,05). El seguimiento mediante ecografía en una media de 68,04 meses de edad (rango 7,5-186,5) y renograma diurético en una media de 50,25 meses de edad (rango 6,6-173,8), evidenciaron mejora en los parámetros arriba señalados en ambos grupos de pacientes, sin diferencias significativas. CONCLUSIONES: En nuestra serie, la PAR es un abordaje con un índice de complicaciones mayor al esperado. Por otra parte, la PMLP es un abordaje seguro y con resultados estéticos y funcionales adecuados.

[Endocrine disrupting chemicals exposure and other parental factors in hypospadias and cryptorchidism etiology]. / Exposición a disruptores endocrinos y otros factores paternos en la etiología del hipospadias y la criptorquidia.

AIM OF THE STUDY: To investigate the association between endocrine disrupting chemicals (EDC) exposure and other paternal factors in the etiology of hipospadias and cryptorchidism. METHODS: A case-control study. Cases were infants between 0 and 6 years of age diagnosed with hypospadias or cryptorchidism in our pediatric urology and general pediatric surgery services during a period of 6 months, and controls were infants with the same range of age attending the same services without any urological problem. Several variables were collected by face-to-face interviews with both parents. After data abstraction, we compared the characteristics of both groups using parametric statistical tests. MAIN RESULTS: A total of 180 patients were studied, 90 cases (45 hypospadias/45 cryptorchidism) and 90 controls with a mean age of 2,37 ± 1.50 years [range 0,5-6]. Median of mother´s age was significantly greater in case group (34,40 ± 5,64 versus 31,74 ± 5,05; p= 0,001). Significant differences were observed between cases and controls in regard to maternal occupational exposure to EDC (mainly phthalates), adjusted Odds ratio (OR) was 3.67 [95% confidence interval (CI): 1.28-10.51; p= 0,018] and regarding the paternal occupational exposure to EDC (mainly pesticides and herbicides), adjusted OR was 6.65 [95% CI: 2.60-17.02; p= 0,001]. Increased risk was also observed in smoking fathers and fathers who drink alcohol, adjusted Odds ratio were 2.36 [95% CI: 1.11. CONCLUSIONS: This study represents a little contribution to the possible etiologic factors of hypospadias and cryptorchidism, further studies with higher statistical power would be needed to prove it.

OBJETIVOS: Investigar la asociación entre la exposición a disruptores endocrinos (DE) y otros factores en el desarrollo del hipospadias y la criptorquidia. MATERIAL Y METODS: Estudio de casos y controles. Consideramos como casos a los niños de entre 6 meses y 6 años de edad diagnosticados de hipospadias y/o criptorquidia que acudieron a las consultas de Urología/Cirugía durante un período de estudio de 6 meses y como controles, a los niños con mismo rango de edad que acudieron a las mismas consultas con otros diagnósticos. Recogimos las variables de interés mediante una encuesta epidemiológica y comparamos los resultados obtenidos en cada grupo mediante tests estadísticos paramétricos. RESULTADOS: Estudiamos 180 pacientes, 90 casos (45 hipospadias/45 criptorquidias) y 90 controles, con edad media de 2,60 ± 1,72 años [rango 0,5-6]. Las medias de edad gestacional y peso al nacer fueron menores en el grupo-caso sin objetivarse diferencias significativas. La edad media materna fue significativamente mayor en el grupo-caso (34,40 ± 5,64 versus 31,74 ± 5,05; p= 0,001). Encontramos asociación significativa entre la exposición ocupacional materna a DE (ftalatos principalmente) y el grupo-caso siendo la Odds ratio (OR) de 3,67 (IC 95%: 1,28-10,51; p= 0,018) y también en la paterna (principalmente a pesticidas/herbicidas) con OR= 6,65 (IC 95%: 2,60-17,02; p= 0,001). Encontramos asociación significativa entre el consumo de tabaco y alcohol paternos y el grupo-caso: OR= 2,08 (IC 95%: 1,11-3,87; p= 0,029) y OR= 2,50 (IC 95%: 1,36-4,57; p= 0,003) respectivamente. CONCLUSIONES: Este estudio supone una pequeña aportación respecto a los posibles factores etiológicos del hipospadias y la criptorquidia, y demuestra la necesidad de estudios ulteriores con mayor potencia estadística para aumentar la evidencia científica de nuestros hallazgos.

[Fertility survey of patients operated on of cryptorchidism in the pediatric age]. / Encuesta de fertilidad en pacientes operados de criptorquidia en edad pediátrica.

OBJECTIVES: To analyze the fertility survey made in a cohort of adults operated on as children for cryptorchidism and for whom clinical and surgical data is available and who were studied 10 years ago by spermiogram and hypophyseal axis. METHODS: A fertility survey including data on style of life and work conditions was sent to the homes of 278 adult patients operated on for cryptorchidism. The 94 surveys received (33.8% of those sent) were analyzed using the SPSS 15.0, carrying out a descriptive and analytic study. We consider persons who achieve pregnancy within a maximum of 12 months with regular sexual activity without the use of contraceptives as having normal fertility. RESULTS: A total of 53 cases of those surveyed (56.4%) attempted to have children, 44 (83.1%) being successful. A total of 34 patients (64.2%) were considered fertile with a mean time of 4.15 months to become pregnant. Nineteen patients (35.8%) had attempted to become parents for more than 12 months and only 10 achieved it (18.9%), 5% in a natural way, 2 with ovulation treatment and 3 by in vitro fertilization, with a mean of 26.8 months. There was no success in becoming parents in 9 cases (16.9%). There are no significant differences between fertilization and localization in laterality of the testicle, age at time of surgery and density on spermiogram. There are significant differences between natural paternity and unilateral or bilateral cryptorchidia. CONCLUSIONS: There is a greater proportion of unilateral cryptorchidias in the group that was successful in having children. We need to increase the number of those surveyed in order to draw significant conclusions in regards to fertility and other clinical situations.

[Our experience with the use of alpha-lithic therapy in the treatment of voiding dysfunction]. / Nuestra experiencia con el uso de alfa-líticos en el tratamiento de la disfunción de vaciado.

INTRODUCTION: Dysfunctional voiding (DV) is due to a dysfunction in the pelvis floor muscles caused by hyperactivity of the urethral sphincter and the musculature of this zone during the voiding phase of the micturition cycle. The treatments used are recommending correct micturition habits, biofeedback and pelvic relaxation exercises. Currently, drugs are also used, such as alpha lithic drugs and injection of botulinic toxin, however its experience in children is limited. OBJECTIVES: Show our experience with the use of alpha-lithics in patients with DV. MATERIAL AND METHODS: Review of patients with DV treated with alpha-lithics in our institution. RESULTS: 6 patients with DV were treated with alpha-lithics (Alfuzosin or Doxazosin). Girl (12 years) with Wolfram Syndrome with significant post-void residual urine, who initially rejected intermittent catéter. Residual urine decreases slightly with treatment, but isn't enough. Boy (7 years) with uretral duplicity and difficulty urine flow without observable stenosis. He had initial improvement but then required continent bladder diversión and vasectomy due to recurrent orchiepididymitis. Boy (5 years) with ureteral-bladder stenosis and ureteral reimplantation with urinary tract infection and vesico-ureteral reflux that did not improve (an anatomic obstruction was subsequently found). Boy (12 years) with tethered cord and pyelonephritis, who rejected intermittent catheter. He hadn't improvement and he required continent bladder diversión. Boy (7 years) with Syringomyelia, operated in another center for vesico-ureteral reflux with ureteral reimplantation, with recurrent urine infections, who hadn't improvement and required continent bladder diversion. Boy (10 years) with resected urethra valves and normal cystoscopy, with episodes of urine retention, without improvement with treatment. CONCLUSION: The role of alpha-lithics in the treatment of dysfunctional voiding in children is limited and of doubtful efficacy. It may be useful in patients with significant post-micturition residue.

[Proposal for a new microsurgical model for the study of induced endometriosis in Wistar rats. Preliminary results]. / Propuesta de un nuevo modelo microquirúrgico para el estudio de la endometriosis inducida en rata Wistar. Resultados preliminares.

The current knowledge status on the patogenesis of endometriosis as well as devastating consequences of disease evolution in women's reproductive health, have promoted researchers advances in a great manner during last years. The immunologic and neangiogenesis systems implication have opened new ways of knowledge over classic theories from the beginning of the xx century. The experimental resesearch, using animal induction models. Below we explain the first steps a new induction model ("PGR1-HotDog"), based on Wistar rats using a new disease autogeneration system, created for te study of the early stages of the endometriosis.

Occupational exposure to endocrine-disrupting chemicals and other parental risk factors in hypospadias and cryptorchidism development: a case-control study.

AIM OF THE STUDY: Endocrine-disrupting chemicals (EDCs) are exogenous agents that are capable of altering the endocrine system functions, including the regulation of developmental processes. The aim of this study was to investigate the association between EDC exposure and other parental factors in the etiology of hypospadias and cryptorchidism. METHODS: A case-control study was conducted. Cases (n = 210) were infants aged between 6 months and 14 years diagnosed with hypospadias or cryptorchidism who attended the authors' hospital over a period of 18 months, and controls (n = 210) were infants within the same range of age and without any urological disorders who attended the outpatient clinic of the same hospital during the same time period. Their selection was independent of exposures. Data on parental occupational exposure to EDCs and other sociodemographic variables were collected through face-to-face interviews and systematically for both cases and controls. Crude and adjusted odds ratios (ORs) were estimated to control for confounding with their 95% confidence interval (CI) by means of logistic regressions. Specifically, three final models of a dichotomous outcome were constructed: one for cryptorchidism, one for hypospadias, and the third considering both malformations together. The Hosmer-Lemeshow test was used to assess the goodness of fit of the models. Their discriminatory accuracy (DA) was ascertained by estimating their areas under the receiver operating characteristic curves area under the curve (AUC) along with their 95% CI. RESULTS: Associations were found between advanced maternal age (OR adjusted = 1.82; 95% CI: 1.14-2.92), mother's consumption of anti-abortives (OR = 5.40; 95% CI: 1.40-38.5) and other drugs (OR = 2.02; 95% CI: 1.31-3.16) during pregnancy, maternal and paternal occupational exposure to EDCs (OR = 4.08; 95% CI: 2.03-8.96 and OR = 3.90; 95% CI: 2.41-6.48, respectively), fathers smoking (OR = 2.0; 95% CI: 1.33-2.99), and fathers with urological disorders (OR = 2.31; 95% CI: 1.15-4.90). Maternal and paternal high educational level could be protective of cryptorchidism (OR = 0.47; 95% CI: 0.28-0.76 and OR = 0.63; 95% CI: 0.42-0.93, respectively). The DA of the models for the whole sample (AUC = 0.75; 95% CI: 0.70-0.79) for cryptorchidism (AUC = 0.76; 95% CI: 0.71-0.82) and for hypospadias (AUC = 0.75; 95% CI: 0.69-0.81) was moderately high. CONCLUSIONS: Advanced age, some parental occupational exposure to EDCs, some drug consumption, smoking, and the father's history of urological disorders may increase risk and predict the developments of these malformations. Studies with higher samples sizes are needed to assess associations between individual EDC occupational exposures and drugs and these malformations.

[Maternal and perinatal data of hypospadic in a 25 year period]. / Análisis de los datos maternos y perinatales en pacientes con hipospadias en un periodo de 25 años.

OBJECTIVE: To analyze maternal and perinatal risk factors related to the onset and severity of hypospadias. MATERIAL AND METHODS: Data of 614 boys operated on hypospadias in our county during 25 years (1972-1998) has been studied. The patients were divided into 3 groups according the malformation severity: proximal, middle, and distal hypospadias. We use two periods, before and after 1980 to analyze the differences in risk factors along the time. RESULTS: There were 9% of proximal hypospadias, 13.6% middle hypospadias, and 77.5% distal hypospadias. We found statistical significance in several risk factors related to severe hypospadias: low birth weight, intrauterine growth restriction, preterm births, and associated malformations (p < 0.001). We did not find statistical significance with maternal age, toxic exposure, associated diseases, and x-ray exposure during pregnancy. After 1980, there were more severe hypospadias and less gestational age. CONCLUSIONS: Several events during pregnancy can contribute to the development of hypospadias in the fetus. In our experience, since 1980 there is a rise in the number and severity of hypospadias.

[Fecundity following prepubertal orchiopexy in unilateral cryptorchism. Experimental study]. / Fertilidad tras orquidopexia prepuberal en la criptorquidia unilateral. Estudio experimental.

Study of fecundation ability following unilateral experimental cryptorchism as a function of the timing of orchiopexy. Two groups of 45 Wistar rats underwent unilateral mechanical cryptorchism and early and late prepuberal posterior orchyopexy, respectively. A third group of 45 rats underwent a dummy intervention. Mating taking place in subgroups of 15 animals at different ages showed that in the experimental animal, and therefore in any non-dysgenetic test, orchiopexy performed at the prepuberal period allows preservation of fecundation ability.

[Clinical and anatomopathological study of the contralateral tests in the unilateral cryptorchidism]. / Estudio clínico y anatomopatológico del teste contralateral en la criptorquidia unilateral.

We have operated on 2204 cryptorchid testis between 1972 and 1995. We took pathological specimens, not only in the undescended testis but also in the normally descended contralateral testis in 122 children. Clinical, surgical and anatomopathological records were reviewed. Moreover, we have studied the spermiograms in 10 young men. We found the Tubular Fertility Index (TFI) was abnormal in 37% of the contralateral testis. In 5 cases we didn't find germinal line. The Tubular Diameter was abnormal in 6.5% of the contralateral testicles only. When we compared the anatomopathological records in the contralateral testis depending on the surgical age and the surgical location of the undescended testis, we didn't find significant differences. When we studied the spermiograms in the 10 young men we obtained some cases where the TFI and the spermiogram were discordant. In conclusion, more than 1/3 of the children with unilateral undescended testis have an abnormal TFI in both testis. Moreover, neither the surgical age nor surgical location of the undescended testis have an influence on the contralateral TFI. Finally, according to the spermiogram results we should question TFI as a fertility index.

[A new clinical evaluation scale for incontinence: its use in anorectal atresias]. / Neuva escala de valoracion clinica de la incontinencia: su aplicacion en las atresias anorrectales.

We present a clinical scoring system to obtain a quantitative and accurate assessment of anorectal incontinence. We evaluate ten components, each of one is pointed between 0 and two, then overall incontinence punctuation (I.P.) is between 0 and 20. Variables define clinical data relative to patient's intestinal habits and hygienic methods, voluntary control degree of defecation and repercussion of patient's incontinence in social and physical capabilities. Punctuation lower than nine concerns to a poor continence; It is fair between nine and 14 points and 15 or higher punctuation indicates a good continence mechanism. This incontinence punctuation method (I.P.) has been applied to 23 patients, aged between two and 17 years, operated because high imperforate anus by PSARP procedure in 15 cases and by abdomino-perineal pull-through according to Romualdi-Soave technique in eight cases. We found statistic significative difference between the group of patients aged less than 5 years and the group aged between 5 and 10 years. There is not statistic significative differences between the two procedures used in surgical treatment, although I.P. is slightly higher in cases operated by PSARP procedure than in cases treated with Romualdi-Soave technique, when we compare the two groups with similar mean age.

[Experimental cryptorchism in the Wistar rat]. / Criptorquidia experimental en rata Wistar.

Experimental cryptorchidism was performed on Wistar rats, fixing the left testicle into the peritoneum for a month. Animals under study (84) were divided into four groups: control, control treated with hCG, cryptorchid and cryptorchid treated with hCG. Cryptorchid testes were biopsied at three, five and eight months and all were excised at 12 months. Cellular counts on spermatogonia, young and late spermatocytes, Sertoli cells and vacuolized Sertoli cells, together with the slough tubular and germinal cell percentage and the tubular diameter, let us affirm by means statistical studies (ANOVA, Chi square) that a testes recovering is already shown at the age of five months, although this recovering still differs from the one shown in the control groups.