Adsorption kinetics and Box-Behnken design optimization for organic dyes on tungsten oxide.

Transition metal oxides have been applied to degrade organic dyes found in water bodies via photocatalysis. To do it, however, is essential that the dye molecules adsorb onto the metal oxide surface. Thus, optimizing the adsorption capacity of the adsorbent increases the probability of reaction between oxidation radicals and organic dye molecules and maximizes the effectiveness per gram of photocatalyst. With this in mind, we studied the adsorption behavior of Methylene Blue (MB) and Acid Orange 7 (AO7), two commonly found pollutants, as a function of dilution's pH, WO3 load, and initial dye concentration. We found out that WO3 adsorbs up to 80% of MB at pH = 6, and 13% of AO7 at pH = 2, although it is unable to adsorb AO7 at the natural pH of the dye dilution. Assuming a pseudo-second order kinetics model for the analysis of the MB adsorption amount, we determined a rate constant k2 = 6 × 10-2(g · mg-1)/min for the adsorption process. We put forward a molecular model for adsorption, driven by concentration gradients and electrostatic interactions. Finally, from a statistical analysis, we determined that pH is the most significant factor for the adsorption of MB and AO7 on WO3, reinforcing the notion that electrostatic interactions are the main mechanism driving the adsorption process. The Box-Behnken design optimization also evinces the key playing role of WO3 load in the adsorption percentage of AO7 and let us establish the optimal load required to maximize adsorption.

Development and assessment of an ex-vivo bench model aimed at laparoscopic ureteric reconstructive techniques.

INTRODUCTION/BACKGROUND: Reconstructive and ablative urologic techniques require special technical mastery, especially the intracorporeal suturing. OBJECTIVE: To report the subjective evaluation of a versatile ex-vivo model aimed to practice laparoscopic ureteric reconstructive techniques (LURT) on box-trainer. STUDY DESIGN: The model is a continuous portion of porcine urinary bladder ("dilated pelvis"), the vesico-ureteral joint ("stenosis") and healthy ureter. All 127 participants (n = 119 urologists and n = 8 paediatric surgeons) performed on the model laparoscopic Anderson-Hynes dismembered pyeloplasty, and then, in the animal model, different LURT procedures (ureteroneocystostomy, ureteric reimplantation and/or dismembered pyeloplasty). The model was subjectively evaluated (face and content validity), through a 12 items questionnaire, based on a Likert scale (1-5 points) and a global question (1-10 points). RESULTS: The total mean rating for 11/12 items was very high (>4points). Only one was rated under 3 points. The overall total mean rating from 1 to 10 points was very high (9.19 ± 0.82 points). In 10/12 items, expert's feedback (content validity) prevailed over non-experts (face validity). DISCUSSION/CONCLUSION: The model was highly accepted for the practice of LURT techniques. Additionally, it is cost-effective, easy to assemble, ethically considerate, and realistic.

Mimicking the temperature gradient between the sow's oviduct and uterus improves in vitro embryo culture output.

This work was designed to determine temperature conditions within the reproductive tract of the female pig and study their impact on ARTs. Temperatures were recorded using a laparo-endoscopic single-site surgery assisted approach and a miniaturized probe. Sows and gilts were used to address natural cycle and ovarian stimulation treatments, respectively. According to in vivo values, IVF was performed at three temperature conditions (37.0°C, 38.5°C and 39.5°C) and presumptive zygotes were cultured in these conditions for 20 h, while further embryo culture (EC) (21-168 h post-insemination) was maintained at 38.5°C. After 20 h, different fertility parameters were assessed. During EC, cleavage and blastocyst stages were evaluated. Sperm membrane fluidity at the experimental temperatures was studied by using differential scanning calorimetry and fluorescence recovery after photobleaching techniques. An increasing temperature gradient of 1.5°C was found between the oviduct and uterus of sows (P < 0.05) and when this gradient was transferred to pig in vitro culture, the number of poly-nuclear zygotes after IVF was reduced and the percentage of blastocysts was increased. Moreover, the temperature transition phase for the boar sperm membrane (37.0°C) coincided with the temperature registered in the sow oviduct, and sperm membranes were more fluid at 37.0°C compared with those of sperm incubated at higher temperatures (38.5°C and 39.5°C). These data suggest that there may be an impact of physiological temperature gradients on human embryo development.

Validation of a new artificial model for simulated training of a laparoscopic vesicourethral anastomosis. / Validación de un nuevo modelo de simulación inorgánica para la anastomosis uretrovesical laparoscópica.

OBJECTIVE: The aim of this study is to prove the effectiveness of a low cost, artificial model for training of a laparoscopic urethrovesical anastomosis. MATERIALS AND METHODS: This study included urologists who attended specialised courses on laparoscopic radical prostatectomy (LRP) held during the period 2015 to 2017. They were divided into 2 groups according to their previous experience in laparoscopic surgery. The tasks performed on the artificial simulator were prostate resection, "task 1", and urethrovesical anastomosis, "task 2". Once these exercises were completed, the study participants filled in an anonymous questionnaire regarding their demographic data and experience level in laparoscopic surgery (LS). In addition, they gave their opinions about the didactic capacity of the artificial organ and evaluated its usefulness as a tool for LRP training. To demonstrate face and content validity, the participants judged the texture, consistency, morphology and evaluated its similarity to the real organ. The assessment was made with a five-point Likert scale. RESULTS: The students were divided into 2groups: 10 experts (Group E) and 12 novices (Group N). The only significant difference between the scores of novices and experts was regarding the inclusion of this tool in the training programs (Group E=5 points versus group N=4.4±0.59, P=.024). The experts' group rated all the items with higher scores than the novices' one. Regarding the general assessment of the simulation model, the novice participants gave an average score of 8.00±0.91 points out of 10, while the experts' group granted higher scores of 9.4±0,51. CONCLUSION: This artificial model has shown to have an elevated face, content and construct validity, as well being an optimal didactic tool for training in the techniques of prostate resection and laparoscopic urethrovesical anastomosis.

Mimicking physiological O2 tension in the female reproductive tract improves assisted reproduction outcomes in pig.

STUDY QUESTION: Is O2 tension in the pig oviduct and uterus affected by the estrous cycle stage and the animal's age, and can the outcome of in vitro embryo development be improved by mimicking these physiological values? SUMMARY ANSWER: O2 tension within the pig reproductive organs is affected by the animal's age, and values close to those measured in vivo have a positive impact on embryo development and quality when used during IVF and embryo culture (EC). WHAT IS KNOWN ALREADY: To obtain a healthy embryo in vitro, it is necessary to adopt a culture microenvironment that approximates physiological conditions. Despite advances in surgical procedures and sensitive probes that allow accurate assessment of in vivo O2 tension, few such studies have been conducted recently in mammals. In addition, no reference values of physiological O2 tension in the reproductive tract exist for large animal models such as pig, and the effect of O2 tension on ART outcomes is unknown. STUDY DESIGN, SIZE, DURATION: This study was conducted in pigs. We measured oviductal and uterine O2 tension (n = 29 and 13, respectively) and then examined how the use of the physiological values in pig IVF and EC affected pig ART output (n = 1447 oocytes). PARTICIPANTS/MATERIALS, SETTING, METHODS: The oviductal and uterine O2 tension at the different stages of the estrous cycle was monitored using a laparo-endoscopic single-site surgery (LESS) assisted approach along with a flexible and thin miniaturized luminescent probe. Two groups of pigs, Large-white × Landrace breed, were used: for the first group, 16 pre-pubertal gilts (5 months old and 95 kg) were induced to ovulate with equine chorionic gonadotropin (eCG) and human chorionic gonadotropin (hCG); in the second group 13 mature sows (24-48 months and 185 kg) were used. IVF and EC were performed at two different O2 tensions: Atmospheric O2 (20%) and the mean in vivo value measured (7%). At 18-20 h post-insemination (hpi), a small sample of presumptive zygotes were fixed, stained and examined under epifluorescence microscopy to assess the fertilization rates. At 48 hpi, cleavage was evaluated under the stereomicroscope. Finally, at 180 hpi, development to the blastocyst stage was quantified, blastocyst morphology was assessed, and embryos were fixed and stained to count the mean cell number per blastocyst. MAIN RESULTS AND THE ROLE OF CHANCE: The mean O2 content within the pig oviduct and uterus was always lower than in ambient air. The average O2 percentage was higher in gilts (10.0%) than in sows (7.6%) (P < 0.0001). The cleavage rate of porcine in vitro fertilized embryos maintained under 7% O2 during IVF and EC was significantly higher (60.0 ± 2.3) compared with those cultured under 20% O2 (32.0 ± 2.2) (P < 0.05). An increase in the number of cells in embryos cultured under the low O2 concentration (88.9 ± 5.9) was observed compared to those cultured under 20% O2 (59.0 ± 5.0) (P < 0.05). LARGE SCALE DATA: None. LIMITATIONS, REASONS FOR CAUTION: Although minimally invasive surgery was used the effect of anesthesia and manipulations on O2 tension within the organs are unknown. WIDER IMPLICATIONS OF THE FINDINGS: Using physiological oxygen concentrations in IVF/EC could improve ART outcomes. STUDY FUNDING AND COMPETING INTEREST(S): This study was funded by Spanish Ministry of Economy and Competitiveness (MINECO) and European Regional Development Fund (FEDER). Grants AGL2012-40180-C03-01 and AGL2015-66341-R. The authors declare no conflict of interest.

Patterns of ambulatory dispersal in Tetranychus urticae can be associated with host plant specialization.

Dispersal can be an essential factor affecting the biological control of pests. Tetranychus urticae Koch (Acari: Tetranychidae) is a cosmopolitan and polyphagous species that may reach the pest status in many cropping systems including clementine orchards, where it may be found both in the trees and the associated flora. In a previous study, we demonstrated that the use of a ground cover of Festuca arundinacea Schreber (Poaceae) offered a better regulation of T. urticae populations than traditional alternatives (bare soil, multifloral wild cover). Therefore, we decided to study the ambulatory dispersal of mites crawling up and down tree trunks in a clementine mandarin orchard grown in association with a F. arundinacea cover for one season. The highest ambulatory migration rate was upward from the cover to the canopy. Multivariate regressions showed that the dynamics of T. urticae populations in the trees was strongly related to that of Phytoseiidae mites, their main natural predators. Surprisingly, canopy populations were not related to those on the ground cover or to those dispersing from it. When T. urticae individuals collected from the ground cover, the tree trunk, and the canopy were subjected to molecular analyses, the optimal number of genetic clusters (demes) was two. One clustergrouped individuals dispersed from the ground cover (e.g. collected on tree trunks) and 27.5% of individuals collected in the ground cover. The second cluster grouped all the individuals collected from trees and 72.5% of those collected in the cover. Interestingly, none of the individuals collected from the tree canopies was grouped with the first deme. This result may be taken as indicative that grass-adapted T. urticae individuals are unable to satisfactorily colonize and establish on the trees and provides evidence that host adaptation can hamper dispersal and establishment of the ground cover deme on trees, contributing to a better natural regulation of this pest species in citrus.

Laparoscopy-assisted transvaginal resection of sigmoid cancer.

OBJECTIVE: To investigate the feasibility and safety of laparoscopy-assisted transvaginal resection of sigmoid cancer. METHODS: From 2009 to 2011 we performed 21 laparoscopy-assisted transvaginal resections of sigmoid cancers. RESULTS: The resected tumours were T1(6), T2(7) and T3(8). The median number of resected lymph nodes was 15. Median operative time was 150 min and no conversion to open technique was necessary. A total of eighteen patients tolerated a liquid diet 24 h after surgery. The average VAS pain score (0 = no pain, 10 = unbearable pain) was 1.8 after 24 h and 1.1 after 48 h. One patient experienced a postoperative ileus, two patients had vaginal spotting with serous flow and three patients suffered urinary tract infections. One patient developed a hernia at the umbilical trocar site that was operated on. None of the sexually active patients reported any differences in sexual activity pre-op and postop on a postoperative questionnaire. After a median of 25 (10-41) months of follow-up, all patients are alive and well, with no evidence of recurrent disease. CONCLUSION: Laparoscopy-assisted transvaginal resection of sigmoid cancer is feasible and safe in a selected group of patients.

[Role of pediatric urologist in the treatment of congenital adrenal hyperplasia: a study of satisfaction and psychosocial aspects]. / Papel del urólogo pediátrico en el tratamiento de la hiperplasia suprarrenal congénita: estudio de satisfacción y aspectos psicosociales.

OBJECTIVE: Study the role of the pediatric urologist in the treatment of CAH and the satisfaction of families and patients to identify the psychosocial aspects that we can improve. MATERIAL AND METHODS: Retrospective study in girls with CAH treated in our center. We reviewed the medical records, analyzing the variables: place of birth, age at diagnosis, surgery, complications and follow up. Analysis of satisfaction and psychosocial aspects by telephone survey. RESULTS: Between 1975-2011, 25 girls with CAH have been treated in our center. Cystoscopy and vaginoscopy was performed before clitoroplasty in 68% (16 girls), adding vulvovaginoplasty in 40% and vaginal descent in the 20%. The mean age was 8.78 +/- 2.30 months. Vaginal stenosis was the main complication (36%), performing introitus plasty in two girls, vaginal expansion in other 2 and dilation of the rest. 15 surveys were made, all expressed satisfaction with treatment, and only 6.67% reported shortages information. With the aesthetic results of the genitoplasty 20% showed dissatisfaction. The family concern was constant at 60%, and sporadic in the rest. 13.3% required psychological support. Currently 80% have normal psychosocial life. CONCLUSION: The HSC requires a multidisciplinary approach right from birth to allow adequate psychosocial development. The pediatric urologist has an important weight in the multidisciplinary treatment. Realizing early feminizing genitoplasty decreases family impact and increases satisfaction. The prolonged follow-up will allow the detection and treatment of complications.

[Urethroplasty with lateral pedunculated flap for complicated hypospadias]. / Uretroplastia con colgajo lateral pediculado para las hipospadias complicadas.

UNLABELLED: With the modern techniques, we can resolve almost the totallity of hypospadias. But there are patients with recurrent fistulas associated to uretral stenosis that can finish all the surgical possibilities. MATERIAL AND METHODS: Retrospective review. Lateral based flap uretroplasty consists in the exposition of the uretra, to reconstruct in one-stage the original neourethra with the lateral skin of the penis. RESULTS: From 2008, we have correct 5 patients with a mean age of 12,1 years (9-15) and a weight of 55,34 kg (22-98 kg). All of them were previously corrected 3 to 7 times, with recurrent fistulas. At the office, stenosis urethral was verified. Surgical correction was made in 90-110 minutes and results were positive in all patients, correcting the stenosis after a follow-up of more than a year. Only the oldest two patients had present minimally glans fistula. CONCLUSIONS: Lateral based flap urethroplasty is a useful technique for the correction of the complicated fistulas, allowing the correction of the fistulas and the stenosis of the urethra.

Isolation and characterization of polymorphic microsatellite markers in Tetranychus urticae and cross amplification in other Tetranychidae and Phytoseiidae species of economic importance.

Tetranychus urticae Koch is a cosmopolitan phytophagous mite considered as the most polyphagous species among spider mites. Population genetic studies using molecular markers such as microsatellites have proven to be extremely informative to address questions about population structure, phylogeography and host preferences. The aim of this study was to increase the available molecular tools to gain insight into the genetic structure of T. urticae populations of citrus orchards, which might help in their management. Five microsatellite DNA libraries were developed using probes with the motifs CT, CTT, GT and CAC following the FIASCO protocol. Positive clones, those that included the insert with the microsatellite, were detected using the PIMA-PCR technique. Combinations of primers were designed on 22 out of 32 new microsatellites loci and their polymorphism was tested in four populations sampled along the eastern coast of Spain. Eleven successful amplifications were obtained. Cross amplification was tested in the tetranychids Aphlonobia histricina, Eutetranychus banksi, E. orientalis, Oligonychus perseae, Panonychus citri, Tetranychus evansi, T. okinawanus and T. turkestani, and the phytoseiids Amblyseius swirskii, A. cucumeris, A. andersoni, Euseius stipulatus, Neoseiulus barkeri, N. californicus, Phytoseiulus persimilis and Typhlodromus phialatus. Eight successful cross amplifications were obtained.

Uretroplastia con colgajo lateral pediculado para las hipospadias complicadas / Urethroplasty with lateral pedunculated flap for complicated hypospadias

Las técnicas habituales de los hipospadias permiten resolver la práctica totalidad de esta patología con resultados muy positivos. Desgraciadamente, existen pacientes que se fistulizan repetidas veces, agotando las posibilidades quirúrgicas. Generalmente se asocian a estenosis uretral. Queremos presentar una técnica que nos ha facilitado la reparación de estos pacientes con resultados esperanzadores . Material y métodos. Revisión retrospectiva de una serie de casos. La técnica del colgajo lateral pediculado consiste en un desmontaje dela uretra y exposición de la misma, para proceder a su reconstrucción en un solo tiempo por medio de la piel lateral de la uretra que se tubulariza sobre la neouretra primitiva. Resultados. Desde 2008 hemos intervenido 5 pacientes con una edad media de 12,1 años (9-15) y un peso de 55,34 kg (22-98 kg).Previamente habían sufrido de 3 a 7 operaciones de corrección de hipospadias, siempre fistulizadas. En consulta se comprobó la estenosis uretral en todos los pacientes. La intervención se realizó en un tiempo de 90-110 minutos y los resultados fueron favorables en todos los pacientes, resolviéndose las estenosis, con un seguimiento medio superior al año. Tan solo los dos pacientes más mayores han presentado mínimas fístulas glanulares. Conclusiones. La uretroplastia con colgajo lateral pediculado es una técnica útil para el tratamiento de los hipospadias complicados permitiendo la resolución de las fístulas y, especialmente, de las estenosis de uretra (AU)

With the modern techniques, we can resolve almost the totallity of hypospadias. But there are patients with recurrent fi stulas associated touretral stenosis that can finish all the surgical possibilities. Material and methods. Retrospective review. Lateral based flapuretroplasty consists in the exposition of the uretra, to reconstruct in one-stage the original neourethra with the lateral skin of the penis. Results. From 2008, we have correct 5 patients with a mean age of 12,1 years (9-15) and a weight of 55,34 kg (22-98 kg). All of them were previously corrected 3 to 7 times, with recurrent fistulas. At the office, stenosis urethral was verified. Surgical correction was made in 90-110 minutes and results were positive in all patients, correcting the stenosis after a follow-up of more than a year. Only the oldest two patients had present minimally glansfistula. Conclusions. Lateral based flap urethroplasty is a useful technique for the correction of the complicated fistulas, allowing the correction of the fistulas and the stenosis of the urethra (AU)

[Design and validation of a training model on paediatric and neonatal surgery]. / Diseño y validación de un programa formativo en cirugía laparoscópica pediátrica y neonatal.

We present our experience in the design and development of a training program in paediatric and neonatal laparoscopic surgery, and the determination of face validity by the attendants. Data included in the present study was obtained from five consecutive editions of our Neonatal and Paediatric Laparoscopic Surgery Course. Our training model, with a total duration of 21 hours, begins with acquisition of knowledge in ergonomics and instrument concepts, after which the attendants develop basic laparoscopic dexterity through the performance of hands-on physical simulator tasks. During the second and third days of the course, surgeons undertook various surgical techniques hands-on animal model. At the end of the training program, a subjective evaluation questionnaire was handed out to the attendants, in which different didactic and organizational aspects were considered. We obtained a highly positive score on all questions concerning the different topics and techniques included in the training program (> or = 9 points over 10). 78,5% of the 54 attendants was in accordance with the course total duration, whilst 21,5% considered that it should be of longer duration. Regarding abilities' self assessment, 79,1% considered themselves capacitated to perform trained procedures on live patients. The presented training model has obtained a very positive valuation score, leading to an increase in the attendants' self confidence in the application of learned techniques to their clinical practice.

Evaluación urodinámica y de la continencia en las ampliaciones vesicales con sigmoides / Evaluation of urodynamics and continence in bladder augmentations with sigmoids

Objetivo. Queremos evaluar nuestra experiencia en las cistoplastias con sigmoides en el manejo de la dilatación del tracto urinario superior y la incontinencia urinaria. Material y métodos. Realizamos un estudio descriptivo retrospectivo de las ampliaciones realizadas con sigmoides (1994-2009). Analizamos parámetros clínicos, quirúrgicos y especialmente urodinámicos, pre/postcistoplastia. Resultados. Hemos realizado 30 cistoplastias con una edad de 10,24años (3-15 años), siguiéndose 8 años (9 meses-15 años). El diagnóstico de base era la vejiga neurógena (63,3%), siendo la indicación principal para la ampliación la afectación del tracto urinario superior 43,3%)y la incontinencia. El procedimiento se asoció a la colocación de esfínter artificial (30%), estoma tipo Mitrofan off (30%) o reimplante ureteral(30%), No existiendo ninguna complicación (..) (AU)

Aim. To evaluate our experience in sigmoid augmentation to manage renal upper tract dilatation and urinary incontinence. Material and methods. Retrospective descriptive study of the augmentation cystoplasties with sigmoid patch. We analyze clinical, urodynamic and surgical parameters. Results. We have make 30 cistoplasties with a mean age of 10.24years (3-15 years) with a mean follow up of 8 years (9 months-15 years).The main diagnosis was neurogenic bladder (63,3%) being the main indication for the augmentation the progressive dilatation of the renal upper tract (43,3%). We associate to the procedure the collocation of an artificial sphinter (30%), Mitrofan off or ureteral reimplantation. There was no major complication. In the urodinamics, the bladders had low (..) (AU)

[Evaluation of urodynamics and continence in bladder augmentations with sigmoids]. / Evaluación urodinámica y de la continencia en las ampliaciones vesicales con sigmoides.

AIM: To evaluate our experience in sigmoid augmentation to manage renal upper tract dilatation and urinary incontinence. MATERIAL AND METHODS: Retrospective descriptive study of the augmentation cystoplasties with sigmoid patch. We analyze clinical, urodinamic and surgical parameters. RESULTS: We have make 30 cistoplasties with a mean age of 10.24 years (3-15 years) with a mean follow up of 8 years (9 months-15 years). The main diagnosis was neurogenic bladder (63,3%) being the main indication for the augmentation the progressive dilatation of the renal upper tract (43,3%). We associate to the procedure the collocation of an artificial sphinter (30%), Mitrofanoff or ureteral reimplantation. There was no major complication. In the urodinamics, the bladders had low capacity, high pression and low compliance. After surgery, urodinamic parameters improve. During follow up, continence improve with more intermittent clean catheterism (median 4/day). Vesical lithiasis was more common late complication with nor acute abdominal surgical illness nor malignancy; 2 patients finished in renal transplantation. Evolution was positive in 66%, and negative in 18,5%. CONCLUSIONS: Sigmoid augmentation cystoplasty is a good technique, that allows urodinamic and continence improvement. The conscience in the importance of intermittent catheterisms reduces the incidence of complications.

Manejo quirúrgico del tumor de Wilms bilateral: Nuestra experiencia con 18 casos / Surgical management of the bilateral wilm's tumor: Our experience with 18 cases

Objetivo. Mostrar nuestra experiencia en el manejo quirúrgico del tumor de Wilms bilateral. Material y métodos. Se analizaron los datos de 18 niños con diagnóstico de TW bilateral entre 1971 y 2007, evaluando la edad al momento del diagnóstico, sexo, presentación clínica, métodos diagnósticos, histología, tratamiento quimioterápico, radioterápico y quirúrgico, complicaciones y el estado clínico actual de los pacientes. Resultados. El 65% de los TW sincrónicos se encontraban en estadios I / II; el 30% mostraban al menos un tumor en estadio III. Un caso en estadio IV (5%). Los pacientes con TW metacrónicos se encontraban en el 100% de los casos en estadios I /II. Todos los tumores fueron de bajo o intermedio grado de malignidad, con predominio del tipo mixto. Las complicaciones quirúrgicas fueron 4 suboclusiones intestinales,2 fístulas ureteropiélicas y 1 quiste urinario.15 niños permanecen convida (83%) con un período libre de enfermedad entre 1 y 24 años, delos cuales 3 se han trasplantado con buena evolución. Un paciente falleció por insuficiencia renal progresiva y otros dos pacientes por evolución de la enfermedad. Conclusiones. La quimioterapia preoperatoria citorreductora permite una cirugía renal más conservadora con una alta tasa de supervivencia (80-90%). El tratamiento quirúrgico individualizado conlleva resecciones más conservadoras y una menor incidencia de insuficiencia renal a largo plazo (AU)

Aim. To show our experience in the surgical management of bilateral Wilms’ tumor. Methods. We have reviewed the medical records of 18 patients diagnosed of bilateral Wilms’ tumor between 1971 and 2007, evaluating age, sex, clinical situation, imaging studies, histology, treatment, complications and follow-up. Results. 65% of patients with synchronous Wilms’ tumor was stageI-II, 30% stage III and 5% stage IV. 100% of patients with metachronous Wilms’ tumor was stage I-II. All the tumors had favourable histology. Surgical complications were: 4 bowel pseudobstructions, 2ureteropielic fistulae and 1 urinary cyst. 15 patients are alive (83%) with a mean follow-up of 12 years.3 of these patients had a renal transplant with a good evolution. One patient died of a progressive renal failure and two patients died of the evolution of the oncological disease. Conclusions. Preoperative chemotherapy allows a conservative surgical resection with a high overall survival (80-90%). Individualized surgical treatment offers a conservative surgical resection with a lower incidence of long-term renal failure (AU)

[Surgical management of bilateral Wilms' tumor: our experience with 18 cases]. / Manejo quirúrgico del tumor de Wilms bilateral: nuestra experiencia con 18 casos.

AIM: To show our experience in the surgical management of bilateral Wilms' tumor. METHODS: We have reviewed the medical records of 18 patients diagnosed of bilateral Wilms' tumor between 1971 and 2007, evaluating age, sex, clinical situation, imaging studies, histology, treatment, complications and follow-up. RESULTS: 65% of patients with synchronous Wilms' tumor was stage I-II, 30% stage III and 5% stage IV. 100% of patients with metachronous Wilms' tumor was stage I-II. All the tumors had favourable histology. Surgical complications were: 4 bowel pseudobstructions, 2 ureteropielic fistulae and 1 urinary cyst. 15 patients are alive (83%) with a mean follow-up of 12 years. 3 of these patients had a renal trasplant with a good evolution. One patient died of a progressive renal failure and two patients died of the evolution of the oncological disease. CONCLUSIONS: Preoperative chemotherapy allows a conservative surgical resection with a high overall survival (80-90%). Individualized surgical treatment offers a conservative surgical resection with a lower incidence of long-term renal failure.

[Ureteral meatotomy associated with vesicostomy, a possible urinary derivation?]. / Meatotomía ureteral asociada a vesicostomía, una posibilidad de derivación urinaria?

AIM: To show our experience in urinary derivation by ureteral meatotomy associated with vesicostomy. METHODS: We reviewed uni or bilateral ureteral meatotomy associated with vesicostomy carried out in our institution between 1989 and 2006. We report 20 patients (15 boys and 5 girls) with ages ranging from 1 month to 13-years-old (median 4,4-years-olds). Nine (45%) had neuropathic bladder, 6 (30%) posterior urethral valves and 5 (25%) vesicoureteral stenosis. RESULTS: Improvement of the ureteral dilatation controlled by ultrasound was demonstrated in 100% of the patients. Improvement of the renal function was observed in the group of patients (5) with renal failure. COMPLICATIONS: 2 bladder prolapses, 1 calculus and 1 postoperative bladder bleeding. CONCLUSIONS: Ureteral meatotomy associated with vesicostomy is an effective urinary derivation in children with obstructive urological conditions with an important dilatation in which ureteral reimplantation seems to be difficult. This derivation avoids bladder dysfunction and the management of the vesicostomy is comfortable by the use of a bag or the nappies.