Válvulas ureterales en el niño. Tratamiento minimamente invasivo mediante laser holmium / Conservative treatmet of ureteral valve with holmium laser in a child

OBJETIVOS: Presentar el manejo terapéutico mínimamente invasivo de la obstrucción unilateral del tracto urinario superior producida por una válvula ureteral.MÉTODO: Descripción del caso clínico, la técnica endourológica utilizada y de los resultados a medio plazo, con apoyo de la literatura publicada al respecto.RESULTADOS: Paciente de 12 años con clínica de dolor en flanco derecho. En la ecografía presentó ureterohidronefrosis derecha con parénquima conservado. La Uro-resonancia magnética reveló la presencia de un defecto de repleción en el tercio medio del uréter derecho y descartó una compresión extrínseca. En la ureterorrenoscopia se observó la válvula ureteral que fue resecada mediante laser holmium. La derivación ureteral se mantuvo 3 semanas. Tras 12 meses del tratamiento la paciente presentó ausencia de clínica y de ureterohidronefrosis derecha en ecografías de control.CONCLUSIONES: El tratamiento endourológico mediante resección de la válvula ureteral obstructiva usando el laser Holmium Dormier es un método poco invasivo seguro y eficaz a corto-medio plazo(AU)

OBJECTIVES: To present the minimally invasive management of an annular ureteric valve causing upper urinary tract obstruction.METHODS: A case report description: endourological technique and medium-term results with review of the published reports.RESULTS: A 12 year old patient with right flank pain was attended. Ultrasound showed right ureterohydronephrosis with conserved parenchyma. Uro-MRI (axial plane) showed dilation down to the middle of the right ureter with a filling defect, without extrinsic compression. Ureterorenoscopy showed a ureteral valve that was resected by holmium laser. Ureteral stent was maintained for 3 weeks. Twelve months after treatment patient has no symptoms and the following ultrasounds did not reveal right ureterohydronephrosis.CONCLUSIONS: Obstructive ureteral valve resection by endourological treatment using a Dornier holmium laser is a safe and effective minimally invasive method according to short and medium term results(AU)

Megalouretra congénita asociada a reflujo bilateral masivo / Congenital megalourethra associated with massive bilateral reflux

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[Endoscopic treatment of vesicoureteral reflux in pediatric patients with the diagnosis of neurogenic bladder. Results and long-term outcome]. / Tratamiento endoscópico del reflujo vésicoureteral en pacientes pediátricos diagnosticados de vejiga neurógena. Resultados y evolución a largo plazo.

OBJECTIVES: To know the results, complications and outcomes of eight patients with the diagnosis of neurogenic bladder (NB) who underwent vesicoureteral reflux surgery by subureteral injection of inert substances, trying to precise its indication in the therapeutic scheme for neurogenic bladder dysfunction. METHODS: Retrospective review of the results and complications recorded during follow-up in eight pediatric patients with NB secondary to various pathologies and the diagnosis of VUR treated by subureteral injection of Teflon paste (1 case), polydimethylsiloxane (6) and dextranomer/hyaluronic acid copolymer (1). RESULTS: In 8 (72.7%) of the 11 ureters treated VUR was cured after first injection. VUR stopped after second endoscopic treatment in 2 of the 3 ureters with persistent VUR. The efficacy of endoscopic treatment after second injection achieved 90.9%. In 2 unilateral cases we observed contralateral VUR, which cured in one case after endoscopic treatment and the other one followed a conservative scheme. Over the follow-up period (Mean FU time 51.8 +/- 28.5 months) 4 cases presented complications. VUR recurred in two: in one contralateral VUR was detected 19 months after first treatment, the other one presented bilateral ureterohydronephrosis with recurrent urinary tract infections and required augmentation cystoplasty. CONCLUSIONS: Endoscopic treatment is an effective option when choosing surgical treatment for VUR in a patient with neurogenic bladder. It is necessary to follow the long-term outcome of patients after surgery, mainly those with abnormal bladder capacity and compliance and active or dyssynergic urethra due to the possibility of recurrence of the VUR.

Tratamiento endoscópico del reflujo vésicoureteral en pacientes pediátricos diagnosticados de vejiga neurógena. Resultados y evolución a largo plazo / Endoscopic treatment of vesicoureteral reflux in pediatric patients with the diagnosis of neurogenic bladder. Results and long-term outcome

Objetivo: Conocer los resultados, complicaciones y la evolución de ocho pacientes diagnosticados de Vejiga neurógena (VN), intervenidos de Reflujo vesicoureteral (RVU) mediante la inyección subureteral de sustancias inertes, intentando precisar su indicación en el esquema terapéutico de la alteración vesical neurógena. Métodos: Revisión retrospectiva de los resultados obtenidos y de las complicaciones evidenciadas durante los controles evolutivos efectuados a ocho pacientes en edad pediátrica con VN secundaria a diferentes patologías, diagnosticados de RVU, tratado mediante inyección subureteral de pasta de teflón (1 caso), polidimetilsiloxano (6) y copolímero de dextranómero y ácido hialurónico (1). Resultados: De los 11 uréteres tratados en 8 (72.7%) el RVU curó después de la primera inyección. De los 3 uréteres con persistencia del RVU, en dos cesó después del segundo tratamiento endoscópico (TE). La eficacia del TE después de la segunda inyección alcanzó el 90.9%. En dos casos unilaterales evidenciamos RVU contralateral que curó mediante TE en uno siguiendo pauta conservadora el segundo. Durante el periodo de seguimiento (tiempo medio: 51.8 +/- 28.5 meses) presentaron complicaciones 4 casos. Reapareció el RVU en dos, observamos RVU contralateral en uno a los 19 meses del primer tratamiento y en otro evidenciamos ureterohidronefrosis bilateral con infecciones urinarias recurrentes que precisó de cistoplastia de aumento. Conclusiones: El TE es una opción eficaz cuando se decide el tratamiento quirúrgico del RVU en un paciente con vejiga neurógena. Es necesario seguir la evolución a largo plazo de los pacientes intervenidos, sobre todo aquellos con capacidad y acomodación vesical alterada y uretra activa o disinérgica, ante la posibilidad de aparición del RVU ya curado (AU)

Objectives: To know the results, complications and outcomes of eight patients with the diagnosis of neurogenic bladder (NB) who underwent vesicoureteral reflux surgery by subureteral injection of inert substances, trying to precise its indication in the therapeutic scheme for neurogenic bladder dysfunction. Methods: Retrospective review of the results and complications recorded during follow-up in eight pediatric patients with NB secondary to various pathologies and the diagnosis of VUR treated by subureteral injection of Teflon paste (1 case), polydimethylsiloxane (6) and dextranomer/hyaluronic acid copolymer (1). Results: In 8 (72.7%) of the 11 ureters treated VUR was cured after first injection. VUR stopped after second endoscopic treatment in 2 of the 3 ureters with persistent VUR. The efficacy of endoscopic treatment after second injection achieved 90.9%. In 2 unilateral cases we observed contralateral VUR, which cured in one case after endoscopic treatment and the other one followed a conservative scheme. Over the follow-up period (Mean FU time 51.8+/- 28.5 months) 4 cases presented complications. VUR recurred in two: in one contralateral VUR was detected 19 months after first treatment, the other one presented bilateral ureterohydronephrosis with recurrent urinary tract infections and required augmentation cystoplasty. Conclusions: Endoscopic treatment is an effective option when choosing surgical treatment for VUR in a patient with neurogenic bladder. It is necessary to follow the long-term outcome of patients after surgery, mainly those with abnormal bladder capacity and compliance and active or dyssynergic urethra due to the possibility of recurrence of the VUR (AU)

[Epididymal cysts in childhood]. / Quistes epididimarios en la infancia.

OBJECTIVES: To retrospectively review all cases of epididymal cysts registered over the last five years; 15 cases have been included. Simple epididymal cysts are a rare pathology in childhood, being most of them diagnosed in puberty. Currently, due to the scarce case series, there is not consensus about the most adequate therapy. METHODS/RESULTS: Mean age at presentation was 11.5 yr. (1-16). 50% were diagnosed incidentally and 29% presented increased scrotal size. 46% of the cases had associated left varicocele (n = 6) and 26% had history of orchiepididymitis. Diagnosis was based on physical examination and confirmed by ultrasound. 40% of the patients underwent surgery and the remainder received conservative treatment without evidence of complications on follow-up. CONCLUSIONS: Due to the benign character and good evolution of all cases of epididymal cysts treated conservatively and the absence of benefit after surgical treatment, we believe that management should be conservative with clinical and ultrasound controls, leaving surgery for cysts with complications. The frequent association between epididymal cysts and varicocele is related to coincidence of both pathologies in the prepuberal age.

Quistes epididimarios en la infancia / Epididymal cysts in childhood

OBJETIVO: Hemos realizado una revisiónretrospectiva de los casos atendidos en los últimos 5años; se han recogido un total de 15 casos. Los quistessimples de epidídimo son patología poco frecuenteen la infancia diagnosticándose la mayoría en la pubertad.Actualmente y debido a la escasa casuística noexiste consenso en la terapéutica más adecuada.METODOS/RESULTADOS: La edad media de presentaciónfue de 11,5 años (1-16).El 50% fueron diagnosticadosde forma incidental y un 29% cursó conaumento de tamaño escrotal. El 46% de los casos presentabanvaricocele izquierdo asociado (n=6) y un26% presentaba antecedentes de orquiepididimitis. Eldiagnóstico se basó en la exploración física con con-firmación ecográfica. Un 40 % fue tratado quirúrgicamentey el resto fue subsidiario de tratamiento conservadorsin constatarse la presencia de complicacionesen estos en los controles posteriores.CONCLUSIONES: Dada la benignidad y la buenaevolución de todos los casos de quistes de epidídimotratados de forma conservadora, y la ausencia debeneficio con el tratamiento quirúrgico, creemos que eltratamiento debe ser conservador con controles clínicosy ecográficos reservando el tratamiento quirúrgico paraaquellos quistes que presenten complicaciones. La frecuenteasociación encontrada entre el quiste epididimarioy el varicocele responde a una coincidencia deambas patologías en la edad peripuberal

OBJECTIVES: To retrospectively review all cases of epididymal cysts registered over the last five years; 15 cases have been included. Simple epididymal cysts are a rare pathology in childhood, being most of them diagnosed in puberty. Currently, due to the scarce case series, there is not consensus about the most adequate therapy. METHODS/RESULTS: Mean age at presentation was 11.5 yr. (1-16). 50% were diagnosed incidentally and 29% presented increased scrotal size. 46% of the cases had associated left varicocele (n = 6) and 26% had history of orchiepididymitis. Diagnosis was based on physical examination and confirmed by ultrasound. 40% of the patients underwent surgery and the remainder received conservative treatment without evidence of complications on follow-up. CONCLUSIONS: Due to the benign character and good evolution of all cases of epididymal cysts treated conservatively and the absence of benefit after surgical treatment, we believe that management should be conservative with clinical and ultrasound controls, leaving surgery for cysts with complications. The frequent association between epididymal cysts and varicocele is related to coincidence of both pathologies in the prepuberal age

[Encrusted pyelitis in a transplanted kidney]. / Pielitis incrustante en riñón trasplantado.

OBJECTIVES: To emphasize the importance of early diagnosis of encrusted pyelitis in kidney transplant patients. METHODS: We report one case of encrusted pyelitis in a 10-year-old girl with a kidney graft who was treated by means of nephrostomy tube irrigation with an acidifier liquid substance. RESULTS: After 16 days of treatment there was a significant decrease of the size of the calcified pyelic plaque, keeping a good renal function afterwards. CONCLUSIONS: This disease should be thought of in every case of kidney transplant patient with negative urine cultures and alkaline pH, and the microbiologist should be alerted of the possibility of urinary tract infection by Corynebacterium.

Pielitis incrustante en riñón trasplantado / Encrusted pyelitis in a transplanted kidney

OBJETIVO: Destacar la importancia del diagnóstico precoz de la pielitis incrustante (PI) en pacientes trasplantados renales. MÉTODO: Presentamos un caso de PI en una niña de 10 años portadora de injerto renal que tratamos mediante irrigación por nefrostomía de una substancia líquida acidificante. RESULTADOS: Tras 16 días de tratamiento se produjo una disminución del tamaño de la placa piélica calcificada, manteniéndose una buena función renal en la evolución posterior. CONCLUSION: En todos los pacientes trasplantados renales con urinocultivos negativos y pH alcalino debemos pensar en esta patología y comunicar al microbiólogo la posibilidad de infección urinaria por Corynebacteriun. (AU)

[Urachal diverticuli. Diagnosis and treatment]. / Divertículos de uraco. Diagnóstico y tratamiento.

OBJECTIVE: To determine the utility of different diagnostic imaging techniques in diverticulum of the urachus and discuss the approach in the incidentally discovered cases such as those detected due to infectious complications. METHODS/RESULTS: We reviewed the literature, with special reference to the diagnostic and therapeutic aspects of diverticula of the urachus. A case that presented with urinary infection and omphalitis, with the characteristic radiological findings, that resolved after surgical treatment and previous antibiotic therapy, is also described. CONCLUSIONS: Ultrasound is useful in the initial evaluation of patients with signs of periumbilical inflammation. If a urachal diverticulum is diagnosed, retrograde cystourethrography should be performed to rule out associated genitourinary pathology or lower urinary tract obstruction. In cases discovered incidentally, we underscore the importance of elective surgery to excise the diverticulum since it could progress to malignancy. In cases with infectious complications, bladder catheterization and antibiotic treatment before performing subsequent elective surgery offer advantages over primary excision. For young patients, we advocate performing the Pfannenstiel incision. This approach offers excellent visualization and exposure of the entire urachus with a minimum surgical scar.

Divertículos de uraco. Diagnóstico y tratamiento / Diverticulum of the urachus: Diagnosis and treatment

OBJETIVO: Establecer la utilidad de las distintas exploraciones radiológicas en el diagnóstico de los divertículos de uraco y discutir la mejor actitud terapéutica tanto en los casos hallados incidentalmente como en aquellos diagnosticados a partir de una complicación infecciosa. MÉTODOS Y RESULTADO: Realizamos una revisión bibliográfica en la que se evalúan las particularidades del manejo diagnóstico-terapéutico de los divertículos de uraco. Presentamos además un caso que debutó con infección urinaria y onfalitis, con hallazgos radiológicos característicos, y resuelto quirúrgicamente después de un período de enfriamiento con antibióticos. CONCLUSIONES: Establecemos la utilidad de la ecografía como primera exploración a realizar ante un paciente con signos inflamatorios periumbilicales. Si se diagnostica un divertículo de uraco, debe practicarse una cistouretrografía retrógrada para descartar patología genito-urinaria asociada u obstrucción del tracto urinario inferior. En los casos hallados incidentalmente, subrayamos la importancia de plantear cirugía programada para su extirpación, dadas las posibilidades de malignización tardía. Cuando se presentan con una complicación infecciosa insistimos en las ventajas del cateterismo vesical y tratamiento antibiótico seguido de excisión diferida, frente a la excisión primaria. En pacientes de corta edad, proponemos la incisión de Pfannenstiel como una vía con buena exposición de todo el uraco y una cicatriz poco visible (AU)