Severe penile fibrotic reaction secondary to a non-absorbable suture: a case report. / Reacción fibrótica peneana severa secundaria a una sutura no absorbible: reporte de un caso.

INTRODUCTION: Circumcision is one of the most frequent urological surgical procedures in the pediatric population globally. Complications, although rare, can be severe. CLINICAL CASE: We present the case of a Senegalese 10-year-old male patient who had undergone ritual circumcision in his early childhood and developed a progressive circumferential tumor in the penile body with no further associated symptoms. Surgical exploration was carried out. A fibrotic-looking penile ring, which was interpreted as an injury secondary to the non-absorbable suturing material used in the previous surgery, was identified. The tissue involved was removed, and on-demand preputioplasty was conducted. Due to technical limitations, the resected tissue could not be analyzed, which means diagnosis could not be histopathologically confirmed. The patient had a favorable progression. CONCLUSIONS: This case demonstrates that the medical personnel in charge of performing circumcisions should be adequately trained in order to prevent severe complications.

INTRODUCCION: La circuncisión es uno de los procedimientos quirúrgicos urológicos más frecuentemente realizados en la población pediátrica en todo el mundo. Las complicaciones, aunque infrecuentes, pueden ser graves. CASO CLINICO: Presentamos el caso de un paciente varón senegalés de 10 años que fue sometido a una circuncisión ritual en la primera infancia y que desarrolló una tumoración circunferencial progresiva en el cuerpo del pene sin otra sintomatología asociada. Se realizó una exploración quirúrgica y se identificó un rodete peneano de aspecto fibrótico que se interpretó como lesión secundaria al material de sutura no absorbible utilizado en la cirugía anterior. Se realizó una exéresis del tejido afecto y una prepucioplastia a demanda. Por limitaciones técnicas, no se pudo analizar el tejido resecado y por tanto no se pudo confirmar histopatológicamente el diagnóstico. El paciente evolucionó favorablemente. CONCLUSIONES: Este caso pone de manifiesto la necesidad de formar adecuadamente al personal que realiza la circuncisión para evitar complicaciones severas.

Single-port transumbilical pediatric cholecystectomy: any benefits for the patient? / Colecistectomía pediátrica por puerto único transumbilical: ¿aporta algo al paciente?

OBJECTIVE: To compare the perioperative results of single-port laparoscopic cholecystectomy (SPLC) with those of laparoscopic cholecystectomy (LC), and to analyze whether there were any differences between both techniques in our patients. MATERIALS AND METHODS: A retrospective, observational analysis was carried out in non-homogeneous groups of patients under 15 years of age undergoing LC and SPLC over a 6-year period. LC was conducted using four ports, while SPLC was performed through an umbilical incision using a wound retractor to which a surgical glove was coupled for the insertion of 3 ports and instruments curved as required. 15 clinical, surgical, and economic variables were compared by means of a univariate and bivariate analysis. RESULTS: 11 patients underwent surgery - 5 through SPLC and 6 through LC. No significant differences were found in terms of mean operating time (SPLC: 144 minutes vs. LC: 139, P= 0.855) or hospital stay, but a slight increase in hospital cost was noted (SPLC: 1,160 € vs. LC: 1,177 €). The cost of LC was 1,322 € vs. 1,367 € for SPLC, with a premium of 44.30 € owing to the use of the wound retractor. None of the patients had perioperative complications, and all of them felt the cosmetic result was excellent. CONCLUSIONS: In our limited experience, the differences between SPLC and LC do not clearly support one or the other. SPLC could provide patients with a better cosmetic result and allow surgeons to improve their skills. However, we believe cholecystectomy is not the most adequate procedure to start a career in single-port laparoscopy because potential complications may be severe.

OBJETIVO: Comparar los resultados perioperatorios de la colecistectomía laparoscópica por puerto único (CLPU) respecto a la colecistectomía laparoscópica (CL) y analizar si, en nuestra casuistica, existen diferencias entre estas tecnicas. MATERIAL Y METODO: Análisis retrospectivo y observacional en grupos no homogeneos de pacientes menores de 15 años sometidos a CL y CLPU durante un periodo de 6 años. La CL se realizó con cuatro puertos y la CLPU mediante una incisión umbilical y colocación de un retractor de heridas al que se acopló un guante quirúrgico, a través del cual se insertaron 3 trócares para el instrumental convenientemente curvado. Se compararon 15 variables clínicas, quirúrgicas y económicas mediante análisis univariado y bivariado. RESULTADOS: Fueron intervenidos 11 pacientes, cinco mediante CLPU y 6 por CL. No hubo diferencias significativas en el tiempo operatorio medio (CLPU: 144 minutos vs. CL: 139, P= 0,855) ni en estancia hospitalaria, aunque sí un ligero aumento del coste hospitalario (CLPU:1.160 €, CL:1.177 €). El coste de la CL fue de 1.322 € frente a 1.367 de la CLPU, con un sobreprecio de +44,30 € debido al uso del retractor de heridas. Ningún paciente presentó complicaciones perioperatorias y todos percibían un resultado cosmético excelente. CONCLUSIONES: Las diferencias entre CLPU y CL, en nuestra reducida experiencia, no justifican decidirse claramente por una u otra técnica. La CLPU podría aportar al paciente un mejor resultado cosmético y al cirujano una mejora de sus habilidades, aunque creemos que la colecistectomía no es la intervención adecuada para iniciarse en laparoscopia por puerto único debido a la gravedad de las posibles complicaciones.

Differential diagnosis of congenital megaprepuce: therapeutic and prognostic relevance. / Diagnóstico diferencial del megaprepucio congénito: relevancia terapéutica y pronóstica.

Congenital megaprepuce is a urological pathology typical of childhood. It can be easily mistaken for other clinical entities such as physiological phimosis or buried penis. Owing to the risk of associated complications - primarily infectious and obstructive complications, with upper urinary tract involvement -, achieving an accurate diagnosis proves particularly significant for early treatment initiation. We present three cases of congenital megaprepuce diagnosed and operated on at our department from January 2019 to May 2020. Diagnosis, therapy, and clinical progression are described.

El megaprepucio congénito es una patología urológica propia de la infancia que puede ser fácilmente confundida con otras entidades clínicas como la fimosis fisiológica o el pene enterrado. Debido al riesgo de complicaciones asociadas, principalmente de carácter infeccioso u obstructivo con afectación del tracto urinario superior, es importante incidir en su correcto diagnóstico de cara a ofertar un tratamiento precoz. Presentamos tres casos de megaprepucio congénito, diagnosticados e intervenidos en nuestro servicio durante el periodo comprendido entre enero de 2019 y mayo de 2020, describiéndose el diagnóstico, la terapéutica empleada y la evolución clínica.

[Cranio-facial-cervical and subglottic hemangioma with respiratory symptoms. A therapeutic emergency].

We describe the case of a 41-day-old infant with a left craniofacial cervical and subglottic hemangioma with respira-tory symptoms. Although infantile hemangiomas are occasional benign vascular tumors that appear predominantly on the skin, 1-2% of patients may have airway lesions that can sometimes cause potentially life-threatening respiratory condi-tions. The decision was made to immediately commence treatment with propranolol, without waiting to complete the exten-sion and syndromic diagnoses. There was a positive clinical response and respiratory symptoms dissipated in twelve hours. Early treatment with beta-blockers is essential for children with hemangiomas whose location causes symptoms or significant functional changes: in some cases it may be a matter of urgency.

[Benefits of pyeloplasty in children with pyeloureteral stenosis: study of somatic development and differential renal function]. / Beneficios de la pieloplastia en niños con estenosis pieloureteral: estudio evolutivo del desarrollo somático y la función renal diferencial.

INTRODUCTION: Under the actual controversy about the management of hydronephrosis for ureteropelvic junction obstruction, our objective has been to evaluate the indications and the effects of pyeloplasty as therapeutic option. MATERIAL AND METHODS: We have reviewed the charts of patients who underwent pyeloplasty, in special concerns at the preoperatory study and the postoperatory control by means of differential renal function (DRF) and half-time drainage (T1/2) on curves of Tc99m MAG3 diuretic renogram, and the effects in the body growth. RESULTS: Between 1995-1999 a total of 16 patients (17 kidneys) underwent pyeloplasty (range: 2 months to 12 years), selecting for the surgical treatment the symptomatic cases and the asymptomatics with alteration of renographic curve and/or DRF. The left side was involved in 12 cases, the right side in 3, and one case was bilateral. The malformation was detected by prenatual ultrasonography on 56.25% of cases and by several symptoms (abdominal pain, infection) in remaIns. The preoperatory DRF was normal (> or = 45%) in 53.3% and deteriorated in 46.7%. Postoperatively, global differential renal function improved significantly, with normal values in 66.7% of kidneys at first control and 75% at the second one. All the cases presented before surgery an obstructed renographic curve, with a half-time superior to 20 minutes; after pyeloplasty the excretory pattern in the diuresis renogram improved significantly, with a normal pattern (T1/2 < 10') in 54%, indeterminate (T1/2 between 11 and 20') in 26.7% and obstructive (T1/2 > 20') in 20% of cases. At the age of surgery, 29.4% of children was below the 50th percentile in weight; postoperatively, only 5.9% was, demonstrating a significant increment in all the cases. CONCLUSIONS: Pyeloplasty is an effective technique for the treatment of ureteropelvic junction obstruction in the selected cases, demonstrating a significant of differential renal function and body growth.

[An analysis of the introduction of pediatric surgery in Spain]. / Análisis de la implantación de la cirugía pediátrica en España.

The specialty of paediatric surgery (P.S.) has been officially recognized in Spain since 1977 as being independent of other surgical areas, and charged with carrying out pathological surgery in paediatric ages. In spite of the considerable progress made, it suffers constant threats, which is why we feel it is opportune to review various aspects of the problems it is currently facing. If we observe how the specialty is distributed, we can see that there are many paediatric services and professorships which do not send their patients to a P.S. specialist. The child's health may suffer as a result of the Administration's decision to allow twenty-two provinces (seven million inhabitants) to go without P.S. We know that many specialties carry out surgery on the paediatric population, so we may well ask: What use is the P.S. qualification? Information was collected from legal sources which indicates the need to hold the qualification of "homologated specialist", given that "the doctor who ventures into specialties which are not his/her own may add a risk factor, and thereby give rise more easily to an offence of negligence". It is time that concepts and competences of the specialty were clarified, and to fight to ensure that all Spanish children should be operated on by legally qualified specialists.

[Prominent ears. Correction using a modified Chongchet technique]. / Orejas prominentes. Correccion mediante la tecnica de Chongchet modificada.

The authors describe their experience with the correction of prominent ears using a modified Chongchet technique. This method is based on the investigations of GIBSON and DAVIS (1958), who showed the tendency of cartilage to warp when one surface is cut. The prominent ear is folded back to produce the desired antihelix fold, which is outlined with methylene blue. An elliptical piece of retroauricular skin is excised. An incision is made through the whole thickness of the cartilage, following the posterior marked linea of the new antihelical fold, from the superior crus to the tail of antihelix. The anterior surface of the cartilage is dissected from the skin. A series of parallel incisions are made through the taut outer layer of the future fold. The tension on that side is released, and therefore it will bend towards the opposite side. The antihelical fold is corrected. This method was used in 192 patients with prominent ears. The results were satisfactory, with a normal-looking fold of antihelix. No recurrence of the deformity was seen.

[The prevention of postoperative pain]. / Prevención del dolor postoperatorio.

An explanation of the different surgical techniques used preoperatively, during the operation or immediately after, to eliminate postoperative pain or reduce the anesthetic level required. An elevation according to such general factors as atmosphere, posture, sedatives, as well as various local or trunk infiltrations and epidural or subarachnoidal blocks.

[Clinical value of anorectal manometry in childhood]. / Utilidad clínica de la manometría anorrectal en la edad pediátrica.

Anatomy and physiology of the anorectum has been studied with manometric techniques in a normal group (n = 34) and in patients with anorectal pathology (n = 477). Authors comment manometric anomalies found in anorectal atresias, Hirschsprung's disease, constipation, neurogenic disorders (spina bifida, sacral agenesia) and the value in diagnosis, prognosis and therapeutic measures that this technique demonstrates.