[Renal dynamics: comparison between diuretic renogram and magnetic resonance imaging]. / Dimámica renal: comparación entre el renograma diurético y la resonancia magnética.

OBJECTIVE: This study aimed to establish a comparison between the data obtained in the renal functional study through magnetic resonance using gadolinium with diuretic (furosemide) charge (MR-Gd/F), on the one hand, and the parameters obtained with the classical diuretic renogram (DR) (differential renal function -DRF- and renographic curve -RC-), on the other hand. MATERIAL AND METHOD: 10 patients were studied, 6 male and 4 female, aged between 1 month and 6 year-old. All the patients were submitted to a MR-Gd/F and a DR. In both cases, furosemide was used as overload. The pathologies observed included syndrome of the pyeloureteral junction, polar vessel, ureter valve, ectopic ureter, duplex kidney, renal dysplasia, renal ectasy, pelvic kidney and horseshoe kidney. The percentage of gadolinium uptake was compared versus the DRF, and the MR curve was compared versus the RC. Surgical treatment was required in 5 cases and an expectancy behaviour was taken in 3 cases. Among the operated patients, the diagnosis accurry was confirmed by the surgery and the pathological study. RESULTS: A 80% consistency was found between the gadolinium uptake and the DRF. There was a 90% correlation between the MR-Gd/F curve and the RC. In two cases, the MR-Gd/F required to modify the surgical criterion -previously based on the DR- and an expectancy behaviour was taken. In 90% of the operated cases, the diagnostic assumption obtained through the MR-Gd/F coincided with the surgical and pathological findings, whereas there was a coincidence in just 60% of the cases studied through the DR (p > 0.0008). CONCLUSIONS: The MR offers a real time study: anatomical, vascular and functional. Good correlation between DR and MR with respect to: (% DRF,%Gd MR and diuretic curve). The MR demonstrates greater precision in diagnosis.The MR allows recognition of non obstructive polar vessels that can then be conservatively managed.

[Comparison between MRI and the techniques traditionally used in the study of uropathies in children]. / Análisis prospectivo y comparativo entre la resonancia magnética y las exploraciones tradicionales utilizadas en el estudio de las uropatías con afectación funcional del niño.

BACKGROUND: To correlate the anatomical and functional information obtained using MRI in comparison to the techniques traditionally used in the study of uropathies, and to compare their physical and socioeconomic impacts. METHODS: For a period of eleven months we carried out a prospective study of 22 patients of both sexes ranging in age from 1 to 180 months. All suffered from one or another uropathy. Fifty-five percent of the patients were from external consultation while 45% had been diagnosed prenatally. The imaging techniques compared with MRI were as follows: echography, renogram, renal DMSA scan, urography and cystography. For the MRI gadolinium was used, as well as general anesthesia in some cases. RESULTS: There was a significant correlation (r = 0.942 p < 0.01) between MRI and the traditional explorations for the diagnosis of hydronephrosis, horseshoe kidney, kidney duplication, kidney hypoplasia and hypertrophy, multicystic kidney, ureterocele, pyeloureteral stenosis, vesicoureteral stenosis, atrophy of the renal artery, and missing kidney. It was not useful for reflux. Comparing to renal function differential on renogram there was an 86% agreement between the results. The average number of visits was 5.7 and missed workdays 4.1. The cost as a result of MRI was less than that for other explorations (Chi2 = 27,909 p < 0.001). CONCLUSIONS: MRI provides the same information, both morphological and concerning functional quality, as well as vascular, as that obtained through traditional explorations. Irradiation with MRI is nil. At times it requires anesthesia. Its practice reduces costs, visits, missed workdays, and travel time. In the future it could probably be possible to carry out cystography and hydric/diuretic overload testing at the same time, the efficacy will be increased.

[Ectopic ureter as cause of urinary incontinence in girls]. / Uréter ectópico como causa de incontinencia urinaria en las niñas.

Continuous urine dripping together with normal micturition is the classical picture of ectopic ureter in girls. During the years 1982 to 1996, eleven girls with such abnormality have been treated at our department. The diagnostic work-up included: intravenous pyelogram (IP), ultrasonography (US), renal scintiscan, cystogram, cystoscopy and/or vaginoscopy, as well as a thorough exam of the external genitalia under general anesthesia. Ten girls had a double renal system, one of them being bilateral; one girl had simple kidneys with renal ectopia. Treatment was heminephrectomy with ureterectomy in 9 cases, ureteroureterostomy with preservation of the hemikidney in one case, and nephrectomy with ureterectomy in the case with a simple system. Urinary incontinence in girls due to ectopic ureter is an uncommon disease. Eigthty-five% of the cases are associated to renal duplication. IP is highly sensible to defect renal duplication; direct vision of the ectopic ureter meatus, canalization and roentgenologic confirmation of the suspected diagnosis are required prior to surgery. Heminephrectomy has been the most common treatment; however, early diagnosis by means of US will promote more conservative surgical approaches.

[Transanastomosis in pyeloplasty of the pyeloureteral junction syndrome: comparative study of 72 cases]. / El tutor transanastomótico en la pieloplastia en el síndrome de la unión pieloureteral: estudio comparativo en 72 casos.

The role of the urinary by-pass and the indications of its utilisation in the treatment of the pyelourethral union syndrome a been a matter of continual controversy. As a results, there have been no objective data for their preference on the part of surgeons. We present an analysis of 72 pyeloplasties carried out by the surgery team of our hospital over a period of 8 years, in order to determine the influence in the postoperative process and the long term effects of its use or nonuse in patients of pediatric age.

[Urofacial Ochoa's syndrome: a clinical case]. / Síndrome urofacial de Ochoa: caso clínico.

An 11 year-old girl had an urinary diversion because of a complex uropathy with vesical sphincter dyssinergism. Her inexpressive face with lost eyes and forced gestures, especially when smiling--her smile looking rather like weeping--was the clue to the diagnosis of Ochoa's syndrome. She underwent psoic bladder fixation, right ureteral reimplantation, bladder neck loosening and cystostomy undiversion. At follow-up, renal function deteriorated. She has recently received a kidney transplantation in another institution, and is now symptom-free.

[Evolution of hypospadias surgery. Comparative study of the various techniques used for 20 years]. / Evolución en la cirugía del hipospadias. Estudio comparativo de las diferentes técnicas empleadas a lo largo de 20 años.

With the purpose of studying the long-term results of the different surgical techniques used for the treatment of hypospadias, we have examined 1186 patients treated in our centre over the last 20 years. To facilitate the comparative study, three well-defined periods have been established: 1974-1981 (165 pts.). Treatment was done in several operative times. Denis Browne and Mathieu's urethroplasties were the techniques more frequently used. Their long-term evolution show keratosis and hairiness of the neourethra, which in 17 patients required a new urethroplasty with vesicle mucosa, as the most serious complication. 1982-1986 (281 pts.). Restoration was done in one single operative time. Magpi, Mathieu and Duckett's techniques were the most frequently used during this period. 1987-1993 (624 pts.). An island flap is added as cutaneous plasty after urethroplasty has been performed. Fistulae were the most frequent complications in all the above time-periods (18, 10 and 7.3%, respectively), followed by stenosis (12, 6.5 and 4.4%) and megaurethra (6.8, 6.7 and 2.9%). The remarkable decrease both in number and seriousness of the complications is due to the island cutaneous flap, hormonal stimulation, use of slow reabsorption materials , silicone probes, silastic foam dressings, caudal anaesthetics and, above all, a better indication for the surgical technique in each case.

[Avoidable complications in the management of a patient with an artificial urinary sphincter]. / Complicaciones evitables en el manejo de un paciente portador de un esfínter urinario artificial.

All the patients who underwent implantation of an artificial urinary sphincter can have three types of complications: those coming from the own patient, mechanical complications and other aleatory ones. J. L. C. A., a 13-year-old boy with secondary neurogenic bladder, received the implantation of a model AUS 800 artificial urinary sphincter for urinary incontinence. After 15 months without problems, he was admitted in our hospital with pump erosion in the scrotum. He was operated on and the pump system was preserved. No plain roentgenograms were made neither before nor after surgical procedure. However, the balloon pressure reservoir was not seen in a control pielogram performed before his discharge from the hospital. Three months later the entire device should be removed because of infection. In the operation a cut off tube was found. A new artificial urinary sphincter was reimplanted and the cuff was placed around the bulbous urethra one year later. Retrospective analysis of this case can help to review the possible complications and their management.

[Changes in traditional techniques in anterior hypospadias]. / Modificaciones a las técnicas tradicionales en el hipospadias anterior.

After confirming that the Magpi and Mathieu techniques are not sufficient for the adequate treatment of 100% of the anterior forms of hypospadias and observing that they often cause defects in the appearance of the meatus, 23 patients were selected and treated with traditional urethroplasties modified by the pyramid technique (King), the Barcat technique, or both, with satisfactory results in all cases. These techniques which are easy to perform, effectively contribute to improving the final appearance of the penis, do not involve major operating time, and present a lower incidence of complications than the traditional techniques.

[Course of the urinary lithiasis treatment in the Surgery Department of a Children's Hospital]. / Evolución del tratamiento de litiasis urinaria en el Servicio de Cirugía de un Hospital Pediátrico.

Records of 90 urolithiasis patients (50 boys and 40 girls) of 5 months to 18 years old (medium 8.7 yr) treated in our department from 1975 to 1993 were reviewed. Family history was found in 25 (27.7%), concomitant uropathy in 9 and predisposing factors to lithogenesis in 35 patients. The most frequent clinical manifestations were hematuria, lumbalgia, dysuria and calculus elimination. Urinary tract infection was found in 26 cases. Treatment modalities used were: medical in 31, extracorporeal shock wave lithotripsy (ESWL) in 12 surgery en 28, endoscopy en 1 and instrumental in 1. Six of 28 surgically treated patients presented residual urolithiasis and another 6 relapsed. Three complications were registered. Recovery from hydronephrosis and/or vesicoureteral reflux was seen in all patients with these lesions.

[Hypospadias. Onlay technique]. / Hipospadias. Técnica en onlay.

The "onlay" urethroplasty is based technically on the following principles: movilization of the urethral plate without dividing it, complete exeresis of chordee beneath it and use of a double faced mucocutaneous vascularized flap from the dorsal aspect rotated to the ventral aspect of penis. Several advantages over other technical modalities make its applicability possible in almost all varieties of hypospadias even in those with severe incurvature. Up to date we have used this technique in 9 patients between 2 and 3 years of age with proximal and middle hypospadias and in one with a considerable middle third fistula, without complications.

[Evolution of pre and postoperative renographic parameters in pyeloreteral juntion obstruction syndrome]. / Evolución de los parámetros renográficos pre y postoperatorios en la cirugía del sindrome de la unión pieloureteral.

With the objective of observing the modifications that the postoperative Diuretic Renography (DR) curve shows and determining how the quantitative parameters of this exploration (Differential Renal Function (DRF), Peak Time (PT), Half Time (HT), descent of maximum activity at 10 min (DMA10)) can be modified, the records of 50 patients affected by unilateral pyeloureteral junction obstruction and without any other associated pathology treated between 1991 and 2001, were revised. The age of the patients was between 1 month and 12 years (average 2 years 7 months). Of the 50 patients, 31 were male and in 28 of the cases were affected on the left side. Patient selection was random. The preoperative evaluation was made using ultrasound (US), intravenous urography (IU), voiding cystourethrography (VCU), and RD. The RD technique and surgical intervention were standardized and the latter were performed by the same surgeon. Postoperative control was made with US and/or IU and RD between 6 and 18 months following surgery, even though total follow up ranged from 6 months to 10 years (average 38.24 months). In all of the cases the follow up US and/or IU results were satisfactory, even though there was residual pyelic ectasia and absence of tension. The morphology of the preoperative curves was mostly obstructive or partially obstructive without lasix response, the curves became normal in 9 cases and partially obstructive with a good response to lasix in 38. The 3 remaining cases that corresponded to the hypofunctional kidney curve did not change. The DRF did not present major variations. The postoperative PT decreased in 62% of the cases. The HT and DMA10 improved in very few cases. In conclusion, it can be said that in spite of a good surgical outcome, the patterns of the postoperative renographic curve often do not completely normalize, major variations in the postoperative DRF are not expected, and with a diminshed postoperative PT a favorable pyeloplasty outcome can be appreciated. HT and DMA10 indicate improvement when they decrease, but do not indicate that the disease has reappeared when they do not change or increase.

[Complications in hypospadias repair: 20 years of experience]. / Complicaciones de los hipospadias y su tratamiento: veinte años de experiencia.

We report a comparative study of the complications in hypospadias repair of 1185 patients treated in our hospital in the last 20 years. They are divided in three well-defined groups: from 1974 to 1981 (265 p.); from 1982 to 1986 (281 p.) and from 1987 to 1993 (624 p.). These were the more frequent complications seen: a) Early as cutaneous necrosis, a severe complication that had an incidence of 3% in the first period. In the second and third period this percentage diminished to 1.9% and 1.1%, respectively. Only one patient developed a total necrosis of the cutaneous island flap that required a new urethroplasty. b) Late: Persistent chordee. It was present in 10% of the children in the first period and it was secondary to an inadequate release of the chordee and cutaneous necrosis. The incidence of the second period was 3.5% and only 2% of patients of the third group suffered it because of a non appropriate selection of the surgical technique. Fistula. It was the most common complication and it was present in 18%, 10% and 7.3% of the patients of each period. We think that the introduction of the cutaneous island flap procedure helped to the improvement in the rate of fistulas. Urethral structure. The incidence was 12% in the first period, 6.5% in the second one and it fall down to 4.4% in the third group due to the triangular flap of the glans. Megaurethra. The incidence was of 6.8% in the first period, 6.5% in the second one and only the 2.9% in the last years.(ABSTRACT TRUNCATED AT 250 WORDS)

[New technique of renal plication for the treatment of severe hydronephrosis]. / Nueva técnica de nefroplicatura en el tratamiento de las hidronefrosis graves.

We present the case of an eleven-year old boy affected of giant hydronephrosis on a unique right pelvic kidney, treated according to an original technique consisting in the use of a free peritoneal flap for the completion of a renal banding to complement Mollard's (1973) and Stewart Hamilton's (1957) nephroplasty procedures.

[Vesico-ureteral reflux in patients with neurogenic bladder dysfunction: causes, types, treatment, development and results]. / Reflujo vesicoureteral en pacientes afectos de disfunción vesical neurogénica: causas, tipos, tratamiento, evolución y resultados.

Thirty one patients, suffering from vesicoureteral reflux, were selected from a group of 106 children affected by neurogenic bladder dysfunction. The causes of neurogenic dysfunction (26 a sequel of spina bifida, 2 agenesis of sacrum and 3 medullar tumors) and grade and type of reflux in the 47 reno-ureteral units (I, 4; II, 20; III, 6; IV, 11, and V, 6) are described. The treatment was medical, combining different bladder expression methods, in 11 ureters, medical plus intermittent catheterization in 36 and surgical in 14. The analysis of the results were: Satisfactory because of complete cure or improvement of the reflux in 35 ureters, un satisfactory in 5 (3 patient died and 2 were diverted and indeterminate in the other 7, whose reflux remained unchanged whose follow up was too short.

[Pediatric cystoscopy. Prospective study]. / Cistoscopia pediátrica. Estudio prospectivo.

Like other European departments, we have been using since 1982 report form on cystoscopic studies, containing a total of 56 data. In this paper we present a model of our cystoscopic report and the results obtained from 185 cystoscopic explorations performed on 153 patients, of both sexes, between the ages of 4 days and 15 years. Cystoscopy which is not routinely performed in all patient suffering from uropathy or reflux, has facilitated the establishment or confirmation of diagnosis in 35% when combined with radiology. It has been useful in postoperative control as well (23%), it has to decide therapeutic policies (15%) and has resolved all ureteral valve cases as well as some ureteral stenosis cases. We explain the technic used in our department for the transfixation and tearing of the valves by electrocoagulation and the absence of any complications using this method. The actual nomenclature of ureteral meatus, based on their location, grade of opening and the frequently associated grade of renal dysplasia, as well as the criteria followed in the endoscopic control of previous ureteral reimplants and the rising pyelography indications, are also explained.

[Nephropathy caused by ventriculo-atrial derivation (shunt nephritis)]. / Nefropatía por derivación ventrículo-atrial ("nefritis por shunt").

We report three patients (one, nine and ten year old) who suffered from secondary nephritis caused by an infection of a ventriculo-atrial shunt. In all three cases diagnosis was made based on persistent hematuria accompanied by prolonged fever of unclear origin and was subsequently confirmed by the presence of staphylococcus in the blood. LCR and prosthesis cultures and in the renal biopsy. The period of time elapsed between the insertion of the shunt, the beginning of the illness and the diagnosis, was variable. In the three cases, the treatment consisted of removal of the infected shunt and insertion of a new one in the peritoneum together with antibiotic treatment. The outcome was successful in only two cases, the third died. The hystological study showed the presence of: membranoproliferative, proliferative and intra and extra capillary glomerulonephritis with diffuse semilunae in each case. We point out the importance of the prosthesis infection by low virulence germs, the continuous dissemination of these into the circulatory system and the production and depositing of antibodies at the renal level.

[Complete urethral duplication]. / Duplicación uretral completa.

OBJECTIVES: Three cases of complete epispadial urethral duplication are described. The limitations of the preoperative evaluation and the importance of a suitable surgical treatment are underscored. METHODS: The patients comprised three boys aged 2, 6 and 7 years. The main cause for consultation was an epispadial opening in the dorsal part of the glans penis in three cases, dorsal curvature of the penis in one and urinary dribbling in the other patient. All the patients were evaluated by cystography and cystoscopy. Only two patients underwent surgery: total excision of the accessory urethra and surgical correction of the chordee via a combined penile retropubic transvesical approach. RESULTS: Cystography and cystoscopy showed complete duplication of the urethra only in two cases; one had coexisting vertebral, cardiac and intestinal anomalies. CONCLUSIONS: Difficulties are encountered in diagnosing this anomaly correctly since the true extent and trajectory of the accessory urethra often cannot be determined. This anomaly warrants total excision of the accessory urethra and surgical correction of the chordee.

[Ureteral multiplicity. Review of case records]. / Multiplicidad ureteral. Revisión de la casuística.

We present distribution by age, sex, clinical picture and clinical examination of 86 cases of renoureteral duplication and one of triplication of which 47 underwent surgical treatment. Intravenous urography provided direct evidence of the existence of duplication in 94%, indirect evidence in 100%, and it disclosed ipsi-or contralateral complications in 23%. Cystography demonstrated vesico ureteral reflux in 62%. Injection of contrast into the ectopic ureteral meatus, echography and gammagraphy provided data of interest in some cases. Accounts are given of indication for operation, approach, surgical procedures, direct of indirect complications, the association of this entity with other pathological conditions and of other procedures which have been described in the treatment of this anomaly.

[Ureterocalycostomy]. / Ureterocalicostomía.

We present the case of a eight-year old girl suffering from severe left hydronephrosis, who was treated in a second operation after failure of a primary pyeloureteral anastomosis, with a direct suture of the ureter to the lower renal calyx, with good result.