[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.

[Ventral diverticula of the bulbous urethra]. / Divertículos ventrales de la uretra bulbar.

We report 5 male patients with ventral diverticula of the bulbous urethra. There was urinary infection in 4 cases, urethral obstruction in 1 and voiding disturbances in 1. Urethral catheterism had been performed previously for various reasons in three patients. Urethroscopic evaluation was successfully completed with endourethral resection in four instances. Based on our morphologic findings we believe that the relationship between these diverticula and dilatation of Cowper's gland ducts is beyond doubt. The cause of this dilatation remains unclear, but mechanical factors, like catheterism, can play a role.

[Prevention of renal injury by means of intermittent catheterization in children with neurogenic bladder secondary to spina bifida]. / Prevención de la lesión renal mediante el cateterismo intermitente en niños con vejiga neurógena secundaria a espina bífida.

We have studied 16 children with spina bifida treated by clean intermittent catheterism (CIC) for at least four years. Those without VUR (5 patients) and those with grades I to III (7 patients) have maintained their kidneys unscared. Furthermore, VUR disappeared in some of them. In 4 children with severe VUR (grades IV and V) a Cohen ureteroneocystostomy was added, and all kept their kidneys stable. Asymptomatic bacteriuria was not modified by CIC and its' eventual relationship with the onset of scarring could not be established. Kidney damage, however, can be detected earlier by decrease of concentration capacity. Continence was obtained in only 30% of the cases, but the addition of some drugs has further improved our results after this study was concluded. CIC should be used as a first choice treatment in most patients with neurogenic bladder due to spina bifida.

[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.

[Combination of drugs and clean intermittent catheterization in the treatment of neurogenic bladder. Effect on continence]. / Asociación de fármacos al cateterismo intermitente limpio en el tratamiento de la vejiga neurógena. Efecto sobre la continencia.

We report the results obtained with the association of drugs with clean intermittent catheterization (CIC) in 13 patients with neurogenic bladder due to spina bifida. The drugs used were bladder muscle relaxants (imipramine), anticholinergic (probanthine) and/or alpha-adrenergic (ephedrine). CIC alone led to acceptable continence in only 24% of cases, whereas with the addition of drugs this proportion increased to 80%. All along the treatment upper urinary tract remained stable in all patients, there were no changes in asymptomatic bacteriuria when present and collateral effects were minimal.