[Minimally invasive endourological management of urinay tract calculi in children]. / Nuestra experiencia en el manejo endourológico de las litiasis en el tracto urinario en la infancia.

BACKGROUND: The urinary tract calculi in children is a very unfrequent problem in the pediatric age group. Endourology plays a major role in pediatric surgery. We reported our experience in endoscopic management of pediatric calculi. METHODS: Eighteen children (age range: 2 year-19 years) underwent endourology procedures for extraction of urinary tract lithiasis in the period from 1992 until 2006. We reviewed retrospectively the following features: calculi size, location, procedures, surgical complications, recurrent, results and time of follow-up. RESULTS: Twenty-one endourolgy procedures were performed: nine ureteroscopies (43%), 10 bladder extractions (47.5%) and two percutaneous nephrolithotomies (9.5%). The mean size bladder stone was 2.75 cm. and 6.3 mm. in the ureteral stones. A patient had staghorn calculi. The stone was located in distal ureter in 7 occasions (33.3%), in upper ureter in 2 (9.5%), in kidney in 2 (9.5%), in bladder in 9 (43%) and in urethra in one (4.7%). Ten cases (55.5%) had urology associated anomalies: 6 patients neurogenic bladder, two bladder exstrophy, one ureterocele and one diagnosed of primary megaureter. Four patients (22%) underwent open surgery for the extraction of the lithiasis: a patient with a bladder stone and three cases with ureteral calculi. Three patients (16, 5%) had recurrence of stones and were successfully treated with endoscopy procedure again. By the moment all the patients are stone-free. The time of follow-up has been 2 years and 6 months (range: 1-13 years). CONCLUSIONS: The endourology is a safe and effective therapeutic option for the management of urinary tract calculi in children. With improvements in instrumentation and technology, it will be possible to expand the patients' selection criterion.

[Is effective the initial management of primary nonrefluxing megaureter with double-J stent?]. / Es util el manejo inicial del megauré6ter primario con catéteres doble J?

BACKGROUND: Initial management of patients with primary nonrefluxing megaureter (PNRM) associated with impaired renal function or with high risk rate of decreased kidney function can be a dilemma. We present our experience in the use of double -J stent in these patients to evaluate the role as a method to decompressing the system, to prevent function loss or to temporize surgical treatment. METHODS: In the period 1996-2006 27 patients were diagnosed of PNRM. The patients classified themselves in two groups according to the initial treatment received: those with conservative management and those managed with double-J stent insertion during 6 months. A complete reassessment was performed after one year from the diagnosis in the first group and three months after stent removal in the second one. Patients underwent uretereral reimplantation if, at assessment, an obstructed excretion pattern was found on diuretic testing. The following data have been studied in each case: age at diagnosis, sex, renal function previous and after the treatment, morbidity associated to the double- J stent insertion, excretion pattern on diuretic testing after initial management, surgical technique, ureteral tapering, outcome and time of follow-up. RESULTS: 15 cases were managed with conservative conduct. After a 12 month period an obstructed excretion pattern was found on diuretic testing in eight patients (53.3%), and an unobstructed one in seven (46.7%). The differential function of the affected kidney got worse in two cases (15.4%), being in one of them less than 10%. Eight patients underwent a surgical intervention (53.3%), in seven cases was performed ureteral reimplantation and in one case was performed a nefrectomy. Four cases needed ureteral tapering (57.1%). Twelve patients were selected to undergo double- J stent insertion for al 6-month period. Stent-related complications developed in 5 cases (41.7%), including upper migration in two cases, distal migration in two and breakthrough infections in one patient. At reassessment three months after stent removal, 6 patients (50%) presented an obstructive pattern and the other cases an unonobstructive pattern (50%). In one of the patients with impaired function, the kidney function got worse until becoming smaller than 10%. Six patients underwent surgical treatment (50%), a nefrectomy and 5 ureteral reimplantation. None case needed ureteral tapering. Mean time of follow-up has been 7 months in the first group and 3 years and 3 months in the second one. CONCLUSIONS: Double-J stent insertion in patients with PNRM is associated with high morbidity and there weren't differents in the final outcomes between both groups, therefore it's necessary to create severe prognosis indicators to use the double-J stent as a method to temporize a surgical treatment.