[Button vesicostomy in newborn: an alternative of classical cutaneous vesicostomy]. / Vesicostomía de botón en el recién nacido: alternativa a la vesicostomía clásica.

PURPOUSE: In newborn and infant with functional and/or anatomical lower urinary tract obstruction, the goals of vesicostomy are to achieve a low pressure bladder, an effective bladder drainage and to prevent urinary tract infection and sepsis. Nonetheless, classical vesicostomy is not free from complications. The aim is to describe a surgical technique of button vesicostomy as an alternative of cutaneous vesicostomy. MATERIAL AND METHODS: 13 newborn and infant, age between 14 and 60 days (median 20 days), twelve male and one female, underwent button vesicostomy. Twelve patients were neurologically normal and one with neurogenic bladder. Surgical technique of button vesicostomy differs from the classical one; it does not require bladder cupula mobilization, the botton is inserted into the bladder at the urachus insertion without suturing the bladder mucosa to the skin, creating a vesico-cutaneous fistula. RESULTS: Button vesicostomy was found to be safe and effective in 96%. Stabilization of upper urinary tracts was achieved in all cases. Botton vesicostomy has made it possible to undergo intermittent catheterization through the button before closure of the vesicostomy, as well as performing standard urodynamic studies through the urethra to evaluate bladder function during follow-up and providing objective data for proper undiversion. There were no complications. Vesicostomy was closed at a median age of twenty months, combined with reconstructive procedures, when necessary. CONCLUSIONS: Button vesicostomy has improved the outcome of the classical vesicostomy. It provides an efficient way for lowering the bladder pressure in the absence of complications, making possible to perform urodynamic studies; the evaluation of bladder function is essential prior to the undiversion.

OBJETIVOS: La vesicostomía clásica tiene como objetivos en el recién nacido-lactante con obstrucción funcional/anatómica del tracto urinario inferior (TUI): conseguir un TUI de baja presión, drenaje efectivo del TUI y disminución de la infección/sepsis urinaria; pero no está exenta de complicaciones (prolapso/estenosis). El objetivo es describir la técnica quirúrgica de la vesicostomía-de-botón y sus resultados como alternativa a la vesicostomía cutánea clásica. MATERIAL Y METODOS: Hemos realizado 13 vesicostomías-de-botón, en pacientes recién nacidos-lactantes; 12 neurológicamente normales y 1 vejiga neurógena. La distribución por edad-sexo: 14-60 días (mediana 20 días); 12 varones y 1 niña. La técnica quirúrgica de la-vesicostomía-de-botón difiere de la clásica en que no precisa movilización de la cúpula vesical, se realiza en la inserción del uraco y evita la fijación de la mucosa vesical a piel, creando una fístula-vésico-cutánea. RESULTADOS: La vesicostomía-de-botón ha sido eficaz y segura en el 96,4%. Ha facilitado la estabilidad vesical en el 100%, así como la realización de estudios urodinámicos estándar-por uretra- durante el evolutivo y como dato objetivo de indicación de desderivación-urinaria. Favoreció la realización de cateterización vesical intermitente, previo al cierre de la vesicostomía. Destacamos la ausencia de complicaciones. El cierre de la vesicostomía se realizó a una media de edad de 20 meses, concomitante con la reconstrucción del TUI, cuando fue necesaria. CONCLUSIONES: La vesicostomía-de-botón ha cambiado el pronóstico evolutivo de la vesicostomía clásica, siendo resolutiva en la normalización de la alta presión del TUI, en ausencia de complicaciones y facilitando la realización de estudios urodinámicos; clave para la desderivación.

[Hyaluronic acid scrotoplasty: minimally-invasive procedure to enhance the volume of scrotum until puberty]. / Escrotoplastia de relleno con acido hialurónico como alternativa mínimamente invasiva para aumentar el volumen escrotal hasta la pubertad.

PURPOSE: There is a controversy concerning infant testicular prosthesis. The problem is that this may necessitate further surgery to insert a larger prosthesis when the child gets older. An alternative strategy is to delay the placement of the definitive prosthesis until the child reaches adolescence. However, the underdeveloped scrotum may fail to accommodate the desired sized testicular prosthesis. We present scrotoplasty using hyaluronic acid gel injection as a minimally-invasive alternative to enhance the volume of scrotum until puberty. MATERIAL AND METHODS: A prospective report of 35 boys younger than seven years old with monorchia underwent injection of hyaluronic acid for scrotal filling. Mean follow-up of 24 months (range 12-48 months). RESULTS: The only complication was early resorption in 2 patients at 8 and 10 months after implantation, respectively. In long-term followup 100 per cent of the families rated the cosmetic appearance as good and 95 per cent were content with the decision regarding placement of a testicular implant irrespective of whether they had been retreated. CONCLUSIONS: It shows that hyaluronic acid gel scrotal injection can provide satisfactory improvement in enhance the volume of scrotum. It is associated with high family and patient satisfaction, and provides a long-lasting result. This technique makes placement of prosthetic testis a very simple procedure that can be performed at the time of diagnostic exploration or orchiectomy, increasing scrotal space until post pubertal definitive prosthesis.

Pyloric atresia and Down's syndrome: prenatal double bubble false sign. / Atresia pilórica y síndrome de Down: falso signo de la doble burbuja prenatal.

Pyloric atresia is a rare malformation, with an incidence of 1:100,000 live newborns. Male to female ratio is 1/1. Typically, it is an isolated malformation, with a good prognosis, but 20-40% of cases present epidermolysis bullosa, and to a lesser extent, multiple intestinal atresias. We present the case of a pre-term newborn prenatally diagnosed with polyhydramnios, duodenal atresia with "double bubble" sign, and suspected Down's syndrome, who eventually had pyloric atresia.

La atresia pilórica es una malformación rara, presenta una incidencia de 1:100.000 recién nacidos vivos y la ratio hombre/mujer es de 1/1. Generalmente es una malformación aislada, con buen pronóstico, pero entre el 20-40% de los casos se asocia a epidermólisis bullosa y en menor frecuencia a otras atresias intestinales múltiples. Presentamos un caso de recién nacido pretérmino con atresia pilórica con el diagnóstico prenatal de polihidramnios, atresia duodenal con signo de 'doble burbuja' y sospecha de síndrome de Down.

[Meconium periorchitis prenatal diagnosis: review of the literature, about 3 cases]. / Periorquitis meconial diagnóstico prenatal: revisión de la literatura, a propósito de 3 casos.

OBJECTIVE: To assess the importance of prenatal ultrasound diagnosis of the fetus carrying meconium periorchitis and its predictive relevance for fetal monitoring and prognosis in the context of acute fetal intestinal disease. MATERIAL AND METHODS: Three male fetuses have been diagnosed of meconium periorchitis in our Unit of Fetal Medicine in the last 5 years. Their prenatal ultrasound diagnoses were: testicular tumor (n=1); Meconium periorchitis with acute fetal intestinal perforation (n=2). Gestational age at diagnosis was 33, 34 and 35 weeks. Ultrasound signs at diagnosis were: Increased size of scrotal zone, with hyperechogenic lesions inside and permanence of peritoneum-vaginal canal; at abdominal zone, echographic signs of intestinal disease with or without meconium peritonitis were found (hyperechogenic lesions, edema of intestinal loops and ascites). All three neonates were assessed postnatally by ultrasound and therapeutic indication. RESULTS: Fetal ultrasound findings influenced both evolution and termination of pregnancy. The diagnosis of meconium periorchitis was confirmed postnatally in all cases: in the 1st case, delivered at term, scrotal tumoral pathology was ruled out and did not require abdominal surgery; the other 2 patients were delivered at the same week of prenatal diagnosis and an inguinal-scrotal surgery with intestinal approach because of meconium peritonitis was performed. No patient underwent orchiectomy, maintaining the teste-epididymal binomial intact. CONCLUSION: Prenatal ultrasound diagnosis of meconium periorchitis requires a strict ultrasound follow-up of the fetus as it is a specific marker of intestinal perforation, which can lead to the termination of pregnancy and avoid appearance of complicated meconium peritonitis.

OBJETIVO: Evaluar la importancia del diagnóstico ecográfico prenatal del feto portador de periorquitis meconial y su relevancia predictiva del seguimiento y pronóstico fetal en el contexto de una enfermedad intestinal fetal aguda. MATERIAL Y METODOS: En los últimos 5 años en la Unidad de Medicina Fetal se han diagnosticado tres fetos varones de periorquitis meconial cuyos diagnósticos ecográficos prenatales fueron: tumor testicular (n=1); y periorquitis meconial con perforación intestinal aguda fetal (n=2). La edad gestacional al diagnóstico fue de 33, 34 y 35 semanas. Los signos ecográficos al diagnóstico fueron: a nivel escrotal, aumento del tamaño, lesiones hiperecogénicas y permanencia del conducto peritoneo-vaginal; a nivel abdominal pueden existir signos ecográficos de enfermedad intestinal con o sin peritonitis meconial (lesiones hiperecogénicas, edemas de asas y ascitis). Los tres neonatos fueron evaluados postnatalmente mediante ecografía comparativa de los hallazgos prenatales e indicación terapéutica. RESULTADOS: Los hallazgos ecográficos fetales influyeron en la evolución y finalización de la gestación. El diagnóstico de periorquitis meconial fue confirmado postnatalmente en los tres casos: en el 1er caso a término, se descartó patología tumoral escrotal y no requirió cirugía abdominal; en los otros dos pacientes se indicó finalizar la gestación tras el diagnóstico prenatal y se realizó cirugía inguino-escrotal y abordaje intestinal por la peritonitis meconial. CONCLUSION: El diagnóstico ecográfico prenatal de periorquitis meconial obliga a un seguimiento ecográfico estricto del feto al ser un marcador específico de perforación intestinal, que puede conllevar la finalización de la gestación y evitar la aparición de una peritonitis meconial complicada.

[Videothorascocopic: approach in thoracic inlet of neurogenic mediastinal tumor in pediatric age]. / Videotoracoscopia asistida: abordaje de tumor neurogénico en la encrucijada cervicotorácica en la edad pediátrica.

We present a 4 year-old patient with precedent of pneumonia and showing an increase of X-ray density in the superior mediastinal. After a year of follow-up and the presence of irritating cough, it is decided to perform studies of image (CT), being diagnosed of a mass in the region of the thoracic inlet which affects up to D4. Video-assisted thoracic surgery is decided and the mass is entirely removed, being the result of the pathological study to ganglioneuroma. Eight months later from, the patient is asymptomatic and without relapse according to the image methods which were carried out.

[Retroperitoneoscopic assisted pyeloplasty for ureteropelvic junction obstruction in children]. / Pieloplastia asistida por retroperitoneoscopia: nuestra experiencia en 30 pacientes.

OBJECTIVES: Description of the retroperitoneoscopic approach in the conventional pyeloplasty for ureteropelvic junction obstruction in children. MATERIAL AND METHODS: From 1998 pyeloplasty assisted by retroperitoneoscopic approach (PARA) was performed in 30 patients. TECHNIQUE: Position in latero-dorsal decubitus and incision of 1 cm in angle costolumbar. We made retroperitoneoscopic space by ball dissection technique and 11 mm Hg pressure. The ureteropelvic junction was extracted through the incision of the port. The UPJ was resected in all patients and Anderson-Hynes pyeloplasty with double PDS 6/0 continuous sutures was performed. In all patients a drainage type Penrose in perirenal space was used. In the last 18 patients a 4F double-J stent was placed. The mean follow-up time was 42 months (range between 6 and 84 months). Operative time, hospital stay, handling of postoperative pain and the postoperative studies have been revised. RESULTS: In all the cases the retroperitoneoscopic approach was good for the identification and dissection of the ureteropelvic junction facilitating the extraction and reconstruction (pyeloplasty) through the mini-incision of the entrance port. The mean operative time was 90 min. (range between 65 and 128 min). We highlight the absence of intraoperative complications. The only postoperative complication has been a pyohydronephrosis in a patient not having internal drainage that was solved by percutaneous pyelostomy and didn't need reintervention. The postoperative handling of the pain was good by means of caudal locorregional anesthesia or by infiltration of the wound with local anesthesic and a dose of Ibuprofeno previous to leave the hospital. The mean hospital stay was 2 days (1-3 days) excluding the complicated case. Postoperative diuretic renograms at the 6 and 18 have shown absence of obstruction in all cases. In the long term follow-up, in 1 case nephrectomy was performed. CONCLUSIONS: The PARA for UPJ obstruction is a safe and effective procedure with the advantage of a minimal invasive approach that facilitates the reconstruction of the ureteropielic junction. Reduces operative time and hospital stay, with appropriate postoperative results. In our experience PARA constitutes an alternative to the conventional pyeloplasty and laparoscopic pyeloplasty in the pediatric age.

[New concepts in the natural history of multicystic dysplastic kidney]. / Nuevos conceptos en la historia natural de la displasia renal multiquística.

OBJECTIVE: Retroperitoneoscopy has shown that US involution is not synonymous with complete regression of the dysplastic renal parenchyma in US-involuted multicystic dysplastic kidney (MCDK). The objective is to analyze the meaning of this results. PATIENTS AND METHODS: 16 patients (nine girls and seven boys) with unilateral MCDK that showed complete involution on ultrasonography, underwent prospectively a retroperitoneoscopic approach. US showed complete cysts involution at the mean age of 10 months (ranging from five to 22 months). All patients underwent a retroperitoneoscopic approach after US involution of the MCDK. The mean age of retroperitoneoscopy was 36 months (ranging from eight to 56 months). RESULTS: The retroperitoneoscopic approach revealed persistence of dysplastic renal tissue in 100% of the patients. The mean lenght of the renal renmant was 2 cm (ranging from 1 and 3.5 cm). All patients had a mean length of stay of less than 24 hours. Anatomo-pathological study of the samples showed a wide spectrum of dysplastic renal tissue and the absence of preneoplastic cells. CONCLUSIONS: Ultrasonography is our method of choice to follow up MCDK until cyst involution takes place. The presence of a dysplastic renal remnant which is not visible on US, requires an appropriate long-term follow up to screen for the growth of tumors. In our experience, retroperitoneoscopy allows the diagnosis and treatment of the displastic renal renmant in the same minimally invasive ambulatory procedure, avoiding long-term development of tumors. Overall, it is our responsibility to sufficiently inform to the family about the persistence of dysplastic renal remnant to facilitate their decision about the best treatment for their child.

[Use of oral anticholinergic therapy in children under 1 years of age with high risk bladder]. / Utilización de anticolinérgicos orales en menores de 1 año portadores de vejiga de alto riesgo.

THE AIM: To assess the effectiveness and safety of the treatment with oral anticholinergic agents (Oxybutin clorure) in patients under 1 year old, and who aree carriers of high risk bladder secondary to neurological illness as well as no neurological one. MATERIAL AND METHODS: Since 1989, we have indicated treatment with anticholinergic agents to 16 patients: 9 patients had neurogenic bladder secondary to: myelomeningocele (n=7) and sacrocoxigeal teratoma (n=2). Others 7 patients had non neurogenic bladder secondary to: posterior urethral valvulas (n=1), valvula-like syndrome (n=4), post-surgery of neonatal giant bladder diverticulum (n=1) and Prune-Belly syndrome (n=1). The urodinamic study was performed during the first six months of life, being "high risk bladder" defined according to the parameters of compliance vesical and pressure of leak at point (PER). Five of the patients showed neonatal cronic renal failure (CRF), who were treated by cutaneus temporary derivation. All patients at treatment with anticholinergic agents at a 0.2 mg/kg/day dose was established; other early adjunctive treatment prior to the closure of the urinary derivation in children with CRF(n=5); or as a part of the conservative treatment (n=3), alone or associate to intermittent bladder catheterization (IBC) (n=8). During the treatment with anticholinergic agents, the cardiac frequency was controlled by EKG registration in 6 patients, being the rest of the children clinicaly controled (skin colour, mouth dryness, cardiac frequency and intestinal function). RESULTS: In all the cases, the minimum duration of the treatment was one year, until the functional stabilization of the urinary tract. It is to underline the absence of secondary complications which would have caused the suspension or the reduction of the treatment at long term. Conventional studies of urologicals image and urodinamic studies, showed the stabilization of the urinary tract and also the preservation of kidney function and not only was demonstrated in those patients with oral anticholinergic agent as their unique treatment, but also in those patients who had previously been derivated. The previous vesical stabilization allowed the optimum result of subsequent corrective surgeries in five patients (ureteroneocystostomy and vesiscotomy clousure. In cases with previous derivation, the treatment with oral anticholinergic agents made easier vesicostomic clousure in the forth quarter of the first year old wih the maintenance of the vesical stability. CONCLUSIONS: The use of oral anticholinergic agents at a dose of 0.2 mg/kg/day, has resulted to be safe as well as effective in the treatment of high risk bladder in infancy those with less than one year of life. In those patients with serious dysplasia by reflux, it contributes to the preservation of kidney function, it makes easier the early desderivation and it also stabilizes in a functional way the bladder as a previous step to subsequent reconstructive surgeries.

[Retroperitoneoscopic nephrectomy: our experience in short-term hospital stay]. / Nefrectomía retroperitoneoscópica. Nuestra experiencia con ingreso en hospital de corta estancia.

OBJECTIVE: To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. MATERIAL AND METHODS: From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney's functional annulations, were: obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). RESULTS: In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. CONCLUSIONS: The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stayis lesser when the nephrectomy was performed by retro peritoneal approach than conventional surgery. Consequently this procedure can be carry out in a short hospital stay.

Microsurgical treatment of varicocele in adolescents.

Between March 1990 and November 1992, 22 adolescents with varicocele, 13 unilateral left and 4 bilateral, are presented. They were all treated with microsurgical techniques by shunting the venous drainage by means of a spermatic inferior epigastric end-to-side anastomosis. The results achieved have been optimum with the clinical disappearance of varicose veins in 100% of the cases and the elimination of the spontaneous reflux of the interna spermatic vein in 100% of the patients shown by echodoppler. This technique enables the establishment of an immediate and physiological testicular venous drainage fundamental for testicular growth and development.

Segmentary splenectomy of the lower tip because of spontaneous rupture of a splenic hemangioendothelioma in a new-born child--a case report.

We present the first exceptional case of splenic hemangioendothelioma, an infrequent and generally asymptomatic benign vascular tumor, here triggering hypovolemic shock through spontaneous rupture of the spleen without prior injury. Conservative treatment of the spleen led us to perform a segmentary splenectomy of the lower tip with total extirpation of the vascular tumour and the acute splenic bleeding was controlled. One year later, splenic functions are normal.

Cocket syndrome: thrombotic-septic disease post-appendicectomy complication.

The incidence of complications following treatment of acute appendicitis in childhood is lower than 5%, while thromboembolic disease at that age is exceptional. The case of a 13-year-old male who was operated on in our pediatric surgery department for acute gangrenous appendicitis is presented. His condition improved until the sixth day after the operation when he suffered thrombosis in both the left iliac vein and the inferior cava. Ultrasonography, plethysmography and computer tomography (CT) studies were carried out and a diagnosis of venous thrombosis was made with an underlying congenital vascular malformation where the iliac vein was compressed by the overlying iliac artery; known as the Cocket syndrome. The etiology diagnosis and treatment of this rare disease in childhood is reviewed.

First Spanish Trauma Registry: analysis of 1500 cases.

OBJECTIVES: To develop the first Spanish Pediatric Trauma Registry to collect and evaluate infomation concerning aspects of injuries in our pediatric population. METHODS: From January 1995 to August 1998, 35,946 children younger than 16 years were treated in our hospital for acute injury: 1500 were admitted and included in our database. Our file registry consists of 108 data points including: patient identification, type, place and mechanism of injury, pre-hospital care, transport, assessment on admission, severity scores, diagnostic studies, injuries, treatment morbidity and mortality. RESULTS: Accidents were more frequent in males (68%) than in females. The predominant age group was 12-15 years of age (34%). Accidents were more frequent in the street (35.1%) than at home (18.9%) or school (13%). Falls and traffic-related accidents were the leading cause of injury (39% and 21.2%, respectively). Two hundred and thirty-five (15.7%) had a Pediatric Trauma Score < or = 8. Fifty of these sustained multiple trauma (33%) (Injury Severity Score > or = 15). Musculoskeletal and head trauma were the most frequent injuries (48.5% and 42.0%, respectively). Surgical or orthopedic procedures were performed in 906 patients (56.5%). The average length of stay was 4.5 days (range 1-93 days). Functional impairment in children older than 4 years of age was found in 413 children (33.3%). We encountered 7 deaths in the 1500 patients, or an overall mortality of 0.5%. These 7 deaths were only seen in the I.S.S. > or = 15 group (50 patients) with 14% mortality. CONCLUSIONS: The goals of this Registry are to establish the epidemiology of our injured pediatric population, to review patient care, to develop prevention programs and to compare results with other centers so that potential deficiencies can be corrected.

[Urinary retention in a child secondary to urethral uric lithiasis]. / Retención urinaria en el niño secundaria a litiasis úrica uretral.

Urinary lithiasis in children is less frequent than in adults. The incidence of uric acid lithiasis in adult population is between 5 to 39% of all lithiasis. Only a third part of the urinary calculi in infancy are compound of uric acid. The most frequent uric lithiasis is that so called endemic. Usually appears in the lower urinary tract and it is not related to metabolic disturbances. We present the exceptional case of an Arabian boy 4 years old who came to the Hospital because he suffered urinary retention secondary to the fixation of uric acid stone in bulbous urethra. The treatment performed was the external urethrotomy and we could removed the stone. We emphasize that the postoperative control was done by uroflowmetry. After one year, the result is satisfactory.

[Renal adenocarcinoma in children. Report of a case]. / Adenocarcinoma renal en el niño. A proposito de un caso.

Description of the accidental finding of a renal adenocarcinoma in a 10-year old boy, after abdominal trauma and with a good evolutive behaviour. The clinical, diagnostic, therapeutical and survival aspects are analyzed, including a literature update of a renal neoformation which shows lower paediatric incidence than Wilm's Tumour or Neuroblastoma.

[Retroperitoneal laparoscopic nephrectomy in children]. / Nefrectomía laparoscópica retroperitoneal en la infancia.

We present two cases of obstructive uropathy nefrectomy through a retroperitoneal approach was performed. Renal differential function by means of a 2,3 dimercapto-succinic acid renal scan showed less than 10% on the ipsilateral kidney to the diagnosis pathology. The size of the kidneys meant no hindrance during its nefrectomy. Morcellation within the organ bag was required for its removal without needing to broaden the 10 mm port opening. The patients were discharged home 48 hours after surgery and they returned to school within the first postoperative week.

[Results of the conservative treatment of severe renal trauma in childhood]. / Resultados del tratamiento conservador del traumatismo renal grave en la infancia.

Surgical treatment of severe renal trauma usually ends in loss of high percentage of kidneys. In consequence of this, in the last decade several authors prefer a conservative management of kidneys severely injured. There include stabilization in Intensive Care Unit, with the goal of preservation the most possible functioning renal tissue. The purpose of this paper is to present the results of conservative management of severe renal trauma in our Center in the last five years. We conclude that this type of management is accurate and effective.

[Indications from the laparoscopic approach in pediatric urological surgery: our experience in 49 patients]. / Indicaciones del abordaje laparoscópico en cirugía urológica pediátrica: nuestra experiencia en 49 pacientes.

OBJECTIVES: To analyse the diagnostic and therapeutic potential of video-assisted laparoscopy in the urology paediatric pathology. We had analysed its indications and results, to measure in disminution of morbidity and hospital stay. PATIENTS AND METHODS: We are treated in our section of Paediatric Urology 49 patients during the period of June 1995 and December 1998, performing 51 laparoscopics procedures. The mean age was 8 years (2-16 years ago). The laparoscopic indications were diagnostic in 33 patients: intra-abdominal testes (n = 16), renal biopsy (n = 17), and terapeuthics in 16 patients (17 laparoscopics procedures): varicoceltomy (n = 7), orchiectomy (n = 1), closure peritoneal-vaginal duct (n = 2), retroperitoneal nephrectomy (n = 6), marsupilazation and omentoplastic in giant lymphocel renal post-transplantation (n = 2). RESULTS: The laparoscopic approach were effective in 100% of diagnostic procedures and 93.4% of therapeuticm procedures. Conversion in 2 cases were necessary to make renal biopsy (n = 1). We hadn't have postoperatives complications and the indices of intraoperative morbidity was of 2.4%. The mean hospital stay was 1.4 days. CONCLUSIONS: We believe that exist indications clinically stabilised of laparoscopic approach--diagnostic and therapeutic--in paediatric urology. There are others indications that its are consider anecdotal in the present but in immediately future these indications will be valid.

[Multicystic renal dysplasia: changes in the contralateral urinary tract]. / Displasia renal multiquistica: alteraciones en el tracto urinario contralateral.

We have treated seven children with multicystic dysplastic kidney during the last 15 years. Three of then presented contralateral upper urinary tract anomalies. Four cases were diagnosed during prenatal period and three during the first term of life. We did analytic kidney function evaluation, ultrasound examination, voiding cystourethrography, radionuclide scan, gammagraphy, excretory urography and urinary cultures in all cases. We have found a vesicoureteral reflux with a bifid pelvis associated in the same child and two other cases with nonobstructive hydronephrosis. The child with vesicoureteral reflux presented also ipsilateral anomalies like a bladder diverticulum and an incomplete urethral duplication. One child with hydronephrosis opposite to the multicystic dysplastic kidney, also presented a bowel malrotation and a congenital cardiopathy, as extra-urologic associated anomalies.