[Severe primary vesicoureteral reflux in infants. A follow-up of 203 cases]. / El reflujo vesicoureteral primario severo en el primer año de la vida. Revisión de 203 casos.

OBJECTIVE: The aim of our study is to analyze the clinic characteristics and evolution of the primary reflux in infants. METHODS: We studied retrospectively 203 infants in our hospital, diagnosed of severe primary renal reflux. Renal ecography and cyclic mictional cystography were practiced in all cases. DMSA was carried out in 181 patients. RESULTS: Renal reflux was unilateral in the 23% of the patients, and bilateral in the remaining cases; 72% of the renal reflux were grade IV and 28% grade V. The renal injuries affected to male infants and reflux grade V. The renal injury was focal (27%), global (44%) and atrophic (29%). The 79% of the patients had conservative treatment, while 21% had surgical treatment. 100% infants with surgical treatment and 94.2% infants with conservative treatment were recovered (Test of Kaplan-Meier). The 27% of patients developed one or several urinary infections, but progression of old renal injuries or formation of new ones, were exceptional (3 cases): While the time the study lasted none of the patients developed chronic renal failure nor arterial hypertension. CONCLUSIONS: 1) The fetal severe primary reflux of the patients was characterized by the following features: to be bilateral reflux, to affect mainly to male infants and to be associated in 33% of cases with a severe renal injury of congenital origin (renal displasia) most of them unilateral. 2) The natural evolution of the reflux goes to spontaneous recovery, so treatment must be conservative. 3) Some patients underwent urinary infections, but progression or formation of new renal injuries were inusual. None of the patients had terminal renal failure nor hypertension and 4) Risk patients would be male infants with bilateral injuries although these are infrequent.

[Syringoceles of Cowper's glands in children]. / Siringoceles de las glándulas de Cowper en niños.

Some tubular or cystic diverticula observed in the ventral wall of the male bulbous urethra that originate from dilatation of Cowper's gland ducts have been termed "syringoceles". They can cause dysuria, hematuria and obstruction. We report 14 syringoceles and 1 true diverticulum from segmental absence of spongious urethra. We review embryology, anatomy and diagnosis in order to determine the best therapeutic approach. We performed endoscopic resection of the distal valve-like border of the diverticulum in 6 patients (42.85%) with good results. The remaining 8 patients, in whom surgery was not indicated, were followed clinically and radiologically.

[Critical evaluation of cystoscopy in pediatric vesico-ureteral reflux]. / Evaluación crítica de la cistoscopia en el reflujo vesicoureteral pediátrico.

Authors report a study on endoscopical evaluation of 110 refluxing ureters in 65 children selected out of a group of 384 with VUR seen between 1977 and 1980. Cystoscopy was only undertaken either in patients with poor response to conservative treatment or in those with associated malformations. Radiologic-endoscopic correlation was rather good: 93% of grade II refluxing orifices were normally located or slightly lateralized, whereas 72% of grade III or IV were so. The length of submucosal tunnel was shorter than 5 mm in 68.75% of refluxing ureters. "Golf-hole" orifices were seen in 2/3 of the cases with grade III or IV reflux. Nevertheless, this correlation was poor in over one third of refluxing units because in these cases cystoscopic evaluation of ureterovesical junction enabled to modify (in either sense) indications for surgery made up only on clinico-radiologic grounds. Endoscopy for evaluation of VUR is justified in selected cases because of this incomplete correlation between radiological and anatomical findings.