[Prevention, diagnosis and treatment of necrotising enterocolitis in newborns less than 32 weeks at birth in Spain]. / Prevención, diagnóstico y tratamiento de la enterocolitis necrosante en recién nacidos menores de 32 semanas al nacimiento en España.

OBJECTIVES: To describe preventive, diagnostic and therapeutic strategies regarding necrotising enterocolitis in Spain and to identify the strengths, areas of further improvement, and future research lines. METHODS: Two questionnaires on the management of preterm infants less than 32 weeks, at risk of, or with diagnosed necrotising enterocolitis, were distributed among selected representatives of the surgeons and neonatologists of the Spanish Neonatal Network (SEN1500) participant hospitals with a Paediatric Surgery Department. RESULTS: Percentage of response was 77.1% of contacted surgeons and 88.6% of neonatologists. There is a written protocol on the diagnosis and medical management of necrotising enterocolitis in 52% of the hospitals, and as regards surgical treatment in 33%. There is wide access to donor bank milk and to staff dedicated to breastfeeding promotion (87%). On the contrary, only 52% of the centres perform delayed cord clamping, and probiotics are used in just 23%. The use of abdominal ultrasound is increasing. There are no large differences as regards duration of antibiotic use and bowel rest, whereas there was as regards antibiotic selection, surgical indication, and type of intervention. CONCLUSIONS: As regards prevention, delayed cord clamping and extended access to donor milk are two possible aspects of further improvement. The observed discrepancies noted in diagnostic and therapeutic aspects are common in precisely the areas where evidence in the literature is weakest.

Dermal regeneration sheet Integra® in management of recurrent Urethrocutaneous fistula after hypospadias surgery.

BACKGROUND: Urethrocutaneous fistula UCF is the most common complication following surgical repair of hypospadias. Currently, the surgical technique mostly used to prevent recurrence employs preputial dartos or testicular tunica vaginalis flaps as a urethral covering. However, autologous tissues are limited in patients with multiple surgeries, and the use of biomaterials as a urethral coverage may represent a good alternative. OBJECTIVE: The goal of the present study is to assess the results and complications of recurrent UCF correction using a dermal bovine regeneration sheet as a urethral covering. MATERIALS AND METHOD: From May 2016 to January 2019, all patients with recurrent UCF of the authors center were repaired using this technique. The inclusion criteria were patients who had undergone one or more unsuccessful UCF repair surgeries and the absence of preputial tissue. The informed consent has been signed by all the patients. Patients were examined in outpatient consultations where their urinary stream was evaluated and a physical examination of the penis was conducted. RESULTS: A total of 12 patients and 13 UCFs were included in the study. The median follow-up was 18 months, (range: 4-26), and only two patients (15%) developed a recurrence of UCF. No complications were observed in the remaining patients (85%) during their evolution. No patient developed a fibrosis increase or loss of elasticity of the tissues in contact with the dermal matrix. CONCLUSION: The use of an Integra® sheet as a urethral covering during urethral fistula surgery appears to be a safe, effective, and easily reproducible option. However, prospective studies with larger numbers of patients should be performed to corroborate these results.

[Integra™ artificial sheet as urethral covering during surgery for hypospadias sequel.] / Lámina artificial Integra® como cobertura uretral durante la cirugía de secuela de hipospadias.

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Diciembre de 2017, por Tardáguila Calvo et al., titulado "Reconstrucción genital con dermis artificial Integra® tras resección radical en un niño con linfangiomatosis difusa" (1), y que hemos leído con gran interés. A propósito de este trabajo creemos conveniente ampliar la información de los autores compartiendo nuestra experiencia previa (2,3).

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Diciembre de 2017, por Tardáguila Calvo et al., titulado "Reconstrucción genital con dermis artificial Integra® tras resección radical en un niño con linfangiomatosis difusa" (1), y que hemos leído con gran interés. A propósito de este trabajo creemos conveniente ampliar la información de los autores compartiendo nuestra experiencia previa (2,3).

[Comparative analysis of the treatment of mid-shaft and distal hypospadias according to Snodgrass surgical repair and Mathieu technique.] / Reparación quirúrgica de los hipospadias medios y distales: análisis comparativo entre la técnica de Snodgrass versus técnica de Mathieu.

OBJECTIVE: The objective of this study is to perform an analysis of the patients who underwent middle and distal penile hypospadias repair using the two most widely used techniques in our Pediatric Urology Unit. MATERIAL AND METHODS: We perform a retrospective analysis of patients with a diagnosis of middle penile and distal penile hypospadias and operated by the Snodgrass or Mathieu technique, between 2011 and 2016 ensuring minimal follow-up of one year. We will analyze the use of each one, the results obtained, and the possible factors that could influence their success rate. RESULTS: A total of 80 patients were included in the study, with a median age of 28 months at surgery (Range: 11 to 151). There were 34 patients (42.5%) with Snodgrass technique and there were 46 patients (57.5%) with Mathieu technique. We have not identified statistically significant differences in complications between both surgical techniques. The percentage of fistulas is higher in Snodgrass urethroplasty (12.1% vs 8.9%), decreasing in the last years of the series, at the same time meatal stenosis is higher in Snodgrass technique (3% vs 2.2%) while the meatal retraction is higher in the urethroplasty of Mathieu (20% vs 15.2%). CONCLUSIONS: The exhaustive selection of patients seems the key in the succesful correction of these types of hypospadias. Despite both techniques are comparable in terms of the type of patient in which they could be applied and both techniques present similar rates in terms of fistulas and stenosis/retractions of the neomeatus (most frequent complications in this type of repairs), we consider that the characteristics of the patient should be prioritized before the preference of the surgeon to reach higher success rates.

OBJETIVO: El objetivo de este estudio es realizar un análisis de los pacientes intervenidos de hipospadias peneanos medios y distales mediante la realización de las dos técnicas más ampliamente utilizadas en nuestra unidad de Urología Pediátrica: técnica de Mathieu versus técnica de Snodgrass. MATERIAL Y MÉTODOS: En este trabajo se realiza un análisis retrospectivo de los pacientes con diagnóstico de hipospadias peneano medio y peneano distal, intervenidos mediante la técnica de Snodgrass o técnica de Mathieu, entre los años 2011 y 2016. El seguimiento mínimo de los pacientes, para formar parte de este estudio, fue de 1 año. Analizamos la tasa de empleo de cada técnica quirúrgica, los resultados obtenidos con cada una de ellas, y los factores que podrían influir en la tasa de éxito de las mismas. RESULTADOS: Un total de 80 pacientes fueron incluidos en el estudio. El 42,5% (34 pacientes) fueron intervenidos según la técnica de Snodgrass y el 57,5% (46 pacientes) según la técnica de Mathieu. La edad media de los pacientes en el momento de la intervención fue de 28 meses (Rango: 11-151). No existieron diferencias estadísticamente significativas entre las complicaciones de ambas técnicas quirúrgicas. El porcentaje de fístulas fue más elevado en la uretroplastia de Snodgrass (12,1% vs 8,9%). Esta complicación sufrió una disminución progresiva en los últimos años de la serie. Así mismo la estenosis meatal también fue más frecuente en la técnica de Snodgrass (3% vs 2,2%) mientras que la retracción meatal se presenta más frecuentemente tras una corrección según técnica de Mathieu (20% vs 15,2%). CONCLUSIONES: A pesar de ser técnicas comparables en cuanto a indicación, resultados y complicaciones presentando tasas similares en cuanto a fistulas y estenosis/ retracciones del neomeato (complicaciones por excelencia en este tipo de reparaciones), la selección de pacientes según las características del pene, debe ser prioritaria sobre la preferencia del cirujano.

Atypical presentation of Leydig cell tumour in three prepubertal patients: diagnosis, treatment and outcomes.

Background Testicular tumours are uncommon in children, accounting for only 1% of all childhood tumours. Prepubertal Leydig cell tumours actively secrete testosterone and as a result, patients typically present with isosexual precocious pseudopuberty, this being the first cause of consultation. We present three cases of Leydig cell tumours in prepubertal patients with an atypical presentation. Methods We studied three cases of Leydig cell tumours in prepubertal boys, who either consulted for testicular asymmetry or were incidentally found to have the tumour in the absence of systemic signs of systemic hyperandrogenism or precocious puberty. In all cases, a well-circumscribed testicular mass was found by testicular ultrasound. The diagnosis was confirmed by histology. In all three cases, testicular enucleation was performed with satisfactory follow-up. Results Following the surgical procedure, during the follow-up, all patients showed a normal testicular volume in comparison with the contralateral testis. No complications were seen during follow-up. Conclusions A testicular ultrasound in children developing asymptomatic testicular asymmetry might be recommended due to its possible hormonal action locally. An early testicular ultrasound, testicular swelling discrepancies, tumour size and androgen production are key factors in the prognosis and management of this type of tumour.

[Use of a urethral plate in surgery for incurving hypospadias]. / Utilización de la placa uretral en la cirugía de los hipospadias con incurvación.

OBJECTIVE: To describe a new procedure for surgical correction of primary hypospadias with chordee. METHODS: The design of the urethral plate divide it in two flaps. Chordee must be resected in order to straighten the penis. Ventral side of neourethra is made with preputial skin or Mathieu procedure. This method has been used in 10 pediatric patients diagnosed of primary hypospadias with chordee. RESULTS: Medium follow-up was 6 months. Only 2 patients developed urethro-cutaneous fistulae and required a new surgical procedure. No reports of meatal stenosis, urethral dilatation or residual curvature were made. 8 patients have excellent cosmetic results and 2 cases were classified as acceptable. CONCLUSIONS: This procedure is a new surgical method for correction of primary hypospadias with chordee.