Infarto medular: etiología, hallazgos radiológicos y factores pronósticos en una serie de 41 pacientes / Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients

Introducción: El infarto medular es una entidad infrecuente y con elevada morbilidad. El diag-nóstico puede resultar difícil y el tratamiento óptimo sigue siendo controvertido. Existen pocasseries de casos publicadas.Métodos: Estudio retrospectivo de infarto medular en un hospital terciario desde 1999 a 2020.Se evaluaron la etiología, las características clínicas, radiológicas, terapéuticas y pronósticas.Resultados: Se incluyeron 41 pacientes (58,5% varones, edad media 61 ±17 a˜nos). Treinta y unpacientes (75,6%) presentaban factores de riesgo vascular (FRV). Presentaron déficit motor (39,95,1%), dolor (20, 48,8%), déficit sensitivo (33, 80,4%) y alteración autonómica (24, 58,5%). Serealizó resonancia magnética (RM) en 37 pacientes (90,2%). En los 12 pacientes con secuenciasde difusión, esta estaba alterada en 10. La localización más afectada fue la dorsal (68,2%). Serealizó estudio vascular en 33 pacientes (80,4%). Las etiologías más frecuentes fueron disecciónaórtica en 6, ateroesclerosis demostrada en estudio vascular en 6, embolia fibrocartilaginosa en6, posquirúrgico en 5 e hipotensión en 4. El mecanismo etiológico quedó sin filiar en 12 pacientes(29,3%), 9 presentaban FRV. Al final del periodo de seguimiento (mediana 24 meses, rangointercuartílico 3-70), 12 pacientes (29,2%) presentaban deambulación autónoma. La presenciade FRV y la paraparesia se asociaron significativamente a peor pronóstico (p < 0,05).Discusión: El infarto medular es una patología con una etiología variada, que en muchos delos pacientes queda sin resolver. El pronóstico funcional a largo plazo es malo y depende de lascaracterísticas basales del paciente y de la forma de presentación clínica. La RM, especialmentelas secuencias de difusión, es útil en el diagnóstico precoz.(AU)

Introduction: Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosiscan be challenging and controversy remains regarding the best treatment. Few case series havebeen published.Methods: We conducted a retrospective review of cases of spinal cord infarction attended ina tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic featureswere assessed.Results: Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) wereincluded in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficitswere recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomicdysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted imageswere available for 12 patients, with 10 showing diffusion restriction. The thoracic region wasthe most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients(80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demons-trated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases),and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 ofthese presented vascular risk factors. At the end of the follow-up period (median, 24 months;interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascularrisk factors and paraparesis were significantly associated with poorer prognosis (P < .05).Discussion: Spinal cord infarction may present diverse aetiologies, with the cause remainingundetermined in many patients. Long-term functional prognosis is poor, and depends on baselinecharacteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, isuseful for early diagnosis.(AU)

Trombectomía mecánica más allá de 6 horas en ictus isquémico agudo con oclusión de gran vaso en territorio carotídeo: experiencia en un hospital terciario / Mechanical thrombectomy beyond 6 hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: Experience at a tertiary hospital

Introducción: La eficacia de la trombectomía mecánica en territorio carotídeo en las primeras 24 horas se ha probado con trabajos publicados recientemente. Métodos: Revisión retrospectiva a partir de un registro prospectivo en nuestro centro de referencia de ictus para valorar la eficacia y seguridad del tratamiento endovascular realizado más allá de las 6 horas de evolución de los síntomas en pacientes con ictus isquémico agudo y oclusión de gran vaso en territorio carotídeo, entre noviembre de 2016 y abril de 2019. Resultados: Se recopilaron datos de 59 pacientes (55,9% mujeres, mediana de edad 71 años). Treinta y tres pacientes fueron detectados al despertar. El 57,6% de los casos fueron traslados secundarios. La mediana de NIHSS basal fue 16. La mediana del ASPECTS fue 8 y el 94,9% de los pacientes presentó > 50% de tejido salvable. El 88,1% de los pacientes logró una recanalización satisfactoria, en 5 pacientes después de 24 horas de evolución. El 67,8% de los casos logró la independencia funcional a los 90 días de seguimiento. Los pacientes que no lograron la independencia funcional presentaban mayor edad, mayor proporción de fibrilación auricular, mayor tiempo punción-recanalización y mayor puntuación NIHSS, tanto basal como al alta. Conclusión: En nuestra experiencia la trombectomía mecánica después de las 6 horas se asoció con buenos resultados de funcionalidad a los 90 días. La edad, la puntuación NIHSS, el tiempo punción-recanalización y la prevalencia de fibrilación auricular fueron factores determinantes en el pronóstico funcional. La eficacia de este tratamiento por encima de las 24 horas merece ser estudiada.(AU)

Introduction: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. Methods: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. Results: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. Conclusion: In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.(AU)

Mechanical thrombectomy beyond 6 hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: experience at a tertiary hospital.

INTRODUCTION: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. METHODS: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. RESULTS: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. CONCLUSION: In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.

Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients.

INTRODUCTION: Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. METHODS: We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. RESULTS: Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P < .05). DISCUSSION: Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.

Characterisation of clays from Alicante province (SE Spain) for use in the recovery of degraded soils.

The goal of this paper is the characterisation of seven clays of the province of Alicante (SE Spain) and their possible use to improve the fertility, water absorption and contaminant-retaining capacity of degraded soils. Three soils affected by the dumping of construction debris were also studied to diagnose the problems and possible recovery strategies. Several physicochemical properties were measured, such as the water holding capacity, soil organic matter, lime, pH, EC and CEC. A high correlationship between mineralogical and elemental composition was obtained. Illite was present in all clays and soils. Some of the samples also contained kaolinite and significant amounts of lime. The CEC, as expected, was more closely related to the organic matter content. Soil organic matter was detected in the second derivative of the FTIR spectra by the signals of the CH2 groups at 2850 and 2919. This way, the FTIR spectrum for the soils of the area would make it possible to estimate both the organic matter content and the CEC. Despite their origin, soils did not show heavy metal pollution; however, salinisation risk seemed to be the most probable cause of degradation. According to the organic matter, lime and illite content, two clays were selected as the most suitable for soil degradation recovery. Furthermore, organic matter additions may help to improve the self-depurative ability of the soil.

Intravenous thrombolysis for acute ischemic stroke in centenarians.

PURPOSE: The benefit of intravenous alteplase is well established for patients with disabling stroke symptoms regardless of age, although data on outcomes in centenarian patients are scarce. We present our experience in patients beyond 100 years. METHODS: Descriptive study including centenarians from our single-centre prospective registry who underwent intravenous thrombolysis with alteplase for acute ischemic stroke in our tertiary university hospital. Clinical variables and functional outcome at 3 months were collected. RESULTS: Four patients, all women, functionally independent (mRS ≤ 2) were included. Treatment with alteplase was applied within 4.5 h of stroke onset. One patient complicated with pneumonia and died. Two patients were functionally independent (mRS ≤ 2) at discharge, while the third was partially dependent (mRS of 3 at discharge), improving after 3 months, (mRS 2). No serious hemorrhagic or systemic adverse events were registered. CONCLUSION: In our experience, intravenous thrombolysis may be beneficial and should be considered in patients over 100 years old with no previous disability.

ANOVA to Compare Three Methods to Track COVID-19 in Nine Countries / ANOVA en la comparación de tres métodos para rastrear COVID-19 en nueve países

ABSTRACT A new coronavirus denominated first 2019-nCoV and later SARS-CoV-2 was found in Wuhan, China in December of 2019. This paper compares three mathematical methods: nonlinear regression, SIR, and SEIR epidemic models, to track the covid-19 disease in nine countries affected by the SARS-CoV-2 virus, to help epidemiologists to know the disease trajectory, considering initial data in the pandemic, mainly 100 days from the beginning. To evaluate the results obtained with the three methods one-way ANOVA is applied. The average of predicted infected cases with SARS-CoV-2, obtained with the mentioned methods was: for United States of America 1,098,508, followed by Spain with 226,721, Italy with 202,953, France with 183,897 United Kingdom with 182,190, Germany with 159,407, Canada with 58,696, Mexico with 50,366 and Argentina with 4,860 in average. The one-way ANOVA does not show a significant difference among the results of the projected infected cases by SARS-CoV-2, using nonlinear regression, SIR, and SEIR epidemic methods. The above could mean that initially any method can be used to model the pandemic course.

RESUMEN Un nuevo coronavirus denominado primero 2019-nCoV y más tarde SARS-CoV-2 fue encontrado en Wuhan, China en diciembre de 2019. El objetivo de este trabajo es comparar tres métodos matemáticos: regresión no lineal, modelos epidemiológicos SIR y SEIR, para rastrear la enfermedad del COVID-19 en nueve países infectados por el virus SARS-CoV-2, con el propósito de ayudar al epidemiólogo a conocer el curso de la pandemia, considerando principalmente sus primeros 100 días. Para evaluar los resultados obtenidos de la aplicación de los tres métodos, se aplicó ANOVA de una vía. El número promedio de casos infectados con SARS-CoV-2, obtenidos con los tres métodos descritos son: para Estados Unidos 1,098,508, seguido de España con 226,721, Italia con 202,953, Francia con 183,897 Reino Unido con 182,190, Alemania con 159,407, Canadá con 58,696, México con 50,366 y Argentina con 4,860 en promedio. El ANOVA de una vía no muestra diferencias significativas entre los resultados de los casos infectados proyectados por SARS-CoV-2, utilizando la regresión no lineal y los métodos SIR and SEIR. Lo anterior podría señalar que cualquiera de los tres métodos estudiados puede modelar el curso de la pandemia en las condiciones descritas para cada uno.

Mechanical thrombectomy beyond 6hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: Experience at a tertiary hospital. / Trombectomía mecánica más allá de 6horas en ictus isquémico agudo con oclusión de gran vaso en territorio carotídeo: experiencia en un hospital terciario.

INTRODUCTION: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24hours after symptoms onset. METHODS: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. RESULTS: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting>50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. CONCLUSION: In our experience, mechanical thrombectomy beyond 6hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24hours after onset merits study.

Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients. / Infarto medular: etiología, hallazgos radiológicos y factores pronósticos en una serie de 41 pacientes.

INTRODUCTION: Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. METHODS: We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. RESULTS: Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P<.05). DISCUSSION: Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.

[Transanal irrigations in patients with constipation and fecal incontinence: results, indications and follow up in our center]. / Irrigación transanal en pacientes con estreñimiento e incontinencia orgánica refractaria. Resultados, indicaciones y seguimiento en nuestro centro.

AIM OF THE STUDY: To present our results with transanal irrigation (TAI) for management of fecal incontinence and fecal constipation without response to other treatments. METHODS: Retrospective study of patients with fecal constipation and/or fecal incontinence treated with TAI between 2013 and 2017. A Rintala questionnaire(1) was carried out comparing pre and post-treatment results. This study was approved by the ethical committee. MAIN RESULTS: Twenty-five patients were included with a median age of 13 years old (range 6-44 years). Nineteen patients had spinal pathology (76%), four colorectal surgery (16%) and two functional constipation (8%). They presented fecal incontinence in 20% of cases, 12% of fecal constipation and 68% both conditions. After a mean follow-up of 1.5 years (1 month-4 years), 52% of the patients abandoned the treatment. The mean Rintala score was 6.8±4 before treatment, and after, resulted to 11.42±2.75 (p=0.001). The main complications throughout the treatment were pain (68%) and balloon leaks (28%). The patients declared as cause of treatment cessation: reduced mobility (15%), fear or misinformation (32%) and pain (76%). All patients with reduced mobility (n=3) left treatment, versus 45% (n=12) of the patients that had full mobility (p=0.17, OR 8.3 [IC95% 0.3-38]). Complementary treatments such as laxatives, enemas or digital extraction were abandoned in 55% of the patients. CONCLUSIONS: Using TAI seems to improve quality of life in patients with fecal constipation and fecal incontinence refractory compared to other treatments. Our abandonment rate was higher than expected, so we believe it is necessary to create a support group to improve follow-ups.

OBJETIVOS: Presentar nuestros resultados con el uso del irrigador transanal (IT) en el manejo intestinal de pacientes con incontinencia fecal o estreñimiento sin respuesta a otros tratamientos. METODOS: Estudio retrospectivo de pacientes con estreñimiento y/o incontinencia fecal refractaria tratados con IT (2013-2017) con el sistema Peristeen® (Coloplast). Se realizó cuestionario Rintala(1), comparando resultados pre y postratamiento. La realización del estudio fue aprobada por el comité de investigación clínica. RESULTADOS: Fueron incluidos en el estudio veinticinco pacientes, mediana de edad 13 años (6-44 años), cuatro no localizables. Diecinueve presentaban patología medular (76%), cuatro cirugías colorrectales (16%) y dos estreñimiento funcional (8%). El 20% aquejaba incontinencia, 12% estreñimiento y 68% ambas condiciones. Tras una mediana de seguimiento de 1,5 años (1 mes-4 años), el 52% abandonó el tratamiento. La puntuación media pretratamiento fue 6,8±4, frente a 11,42±2,75 tras su empleo (p=0,001), disminuyendo el número de escapes con repercusión positiva en actividades diarias. Las complicaciones principales fueron dolor (68%) y expulsión del balón (28%). Refirieron como causa de abandono: dificultad de uso por movilidad reducida (15%), miedo o desinformación (32%) y dolor (76%). El 100% de pacientes con movilidad reducida (n=3) abandonó el tratamiento, frente al 45% (n=12) en el resto (p=0,17, OR 8.3 [IC95% 0,3-38]). El 55% de los pacientes dejaron de utilizar laxantes, enemas o extracción digital. CONCLUSIONES: El uso de IT parece mejorar la calidad de vida en pacientes con estreñimiento e incontinencia de causa orgánica refractaria. La tasa de abandono fue mayor de la esperada, por lo que creemos necesaria la creación de un grupo de apoyo que mejore el seguimiento.

[Long-term renal function in Wilms tumor survivors]. / Función renal a largo plazo en supervivientes de tumor de Wilms.

OBJETIVE: To evaluate long-term renal function and morbimortality in non-syndromic Wilms tumor (WT) survivors. METHODS: Retrospective study about WT patients treated in 1993-2017, according to SIOP protocols. Mortality, glomerular filtration rate (GFR), prevalence of hypertension and requirement of dialysis and renal transplant were evaluated. Chronic kidney disease (CKD) was defined as GFR <90 ml/min/1.73 m2. RESULTS: Thirty-nine children were treated in the 25 analyzed years. Median time of follow-up was 6 years (0.5-21 years). 48% (19 patients) debuted with stage I or II. Four cases had high-grade histo-logy. Mortality rate was 10%. GFR data were found in 37 patients. Chronic kidney disease (grade I-II) turned up in 6 patients (16%). No patient required renal replacement therapy or renal transplant. 16% of patients developed CKD in both unilateral and bilateral WT, (p>0.05); OR 1.04 (IC 95% 0.09-10.9). Identical results were obtained comparing patients treated with or without radiotherapy (16%). Children with stage I-III had CKD in 11% vs. 40% of patients with stage IV (p=0.12); OR 5.3 (IC 95% 0.61-45). None of them presented hypertension in addition. CONCLUSIONS: In the current study the prevalence of CKD was low but not negligible, although no patients required renal replacement therapy or renal transplant. Bilateral renal involvement and radiotherapy were not associated with CKD development. Metastatic disease determines a higher risk of CKD.

OBJETIVOS: Evaluar la función renal y la morbimortalidad a largo plazo, en supervivientes de tumor de Wilms (TW) no sindrómico. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con TW entre 1993-2017 tratados según protocolos SIOP. Evaluamos mortalidad, filtrado glomerular (FG), prevalencia de hipertensión arterial (HTA), necesidad de diálisis y trasplante renal. Se definió enfermedad renal crónica (ERC) como FG <90 ml/min/1,73 m2. RESULTADOS: En los 25 años analizados se trataron 39 pacientes con edad media diagnóstica de 3,6 años (0,3-11 años). Mediana de seguimiento 6 años (0,5-21 años). El 48% (19 pacientes) debutaron con estadio I o II. Cuatro pacientes presentaron histología de alto riesgo (10%). La mortalidad fue del 10%. El 16% (6 pacientes) desarrolló ERC (grados I-II). Ningún paciente precisó terapia renal sustitutoria (TRS) o trasplante. La presencia de ERC tanto en enfermedad unilateral como bilateral fue del 16%, p>0,05; OR 1,04 (IC 95% 0,09-10,9). Se obtuvieron idénticos resultados (16%) comparando pacientes que recibieron radioterapia frente a aquellos que no. Los pacientes en estadio I, II y III presentaron una prevalencia de ERC del 11% vs. 40% en estadio IV (p=0,12); OR 5,3 (IC 95% 0,61-45). Ningún paciente asoció HTA crónica. CONCLUSIONES: En el presente estudio la prevalencia de ERC en supervivientes de TW no sindrómico es baja pero no desdeñable, aunque ninguno precisó trasplante renal o TRS. La presencia de enfermedad bilateral y la radioterapia no se asociaron al desarrollo de ERC. La enfermedad metastásica condiciona un riesgo mayor de ERC.

Irrigación transanal en pacientes con estreñimiento e incontinencia orgánica refractaria. Resultados, indicaciones y seguimiento en nuestro centro / Transanal irrigations in patients with constipation and fecal incontinence: results, indications and follow up in our center

Objetivos: Presentar nuestros resultados con el uso del irrigador transanal (IT) en el manejo intestinal de pacientes con incontinencia fecal o estreñimiento sin respuesta a otros tratamientos. Métodos: Estudio retrospectivo de pacientes con estreñimiento y/o incontinencia fecal refractaria tratados con IT (2013-2017) con el sistema Peristeen® (Coloplast). Se realizó cuestionario Rintala(1), comparando resultados pre y postratamiento. La realización del estudio fue aprobada por el comité de investigación clínica. Resultados: Fueron incluidos en el estudio veinticinco pacientes, mediana de edad 13 años (6-44 años), cuatro no localizables. Diecinueve presentaban patología medular (76%), cuatro cirugías colorrectales (16%) y dos estreñimiento funcional (8%). El 20% aquejaba incontinencia, 12% estreñimiento y 68% ambas condiciones. Tras una mediana de seguimiento de 1,5 años (1 mes-4 años), el 52% abandonó el tratamiento. La puntuación media pretratamiento fue 6,8±4, frente a 11,42±2,75 tras su empleo (p=0,001), disminuyendo el número de escapes con repercusión positiva en actividades diarias. Las complicaciones principales fueron dolor (68%) y expulsión del balón (28%). Refirieron como causa de abandono: dificultad de uso por movilidad reducida (15%), miedo o desinformación (32%) y dolor (76%). El 100% de pacientes con movilidad reducida (n=3) abandonó el tratamiento, frente al 45% (n=12) en el resto (p=0,17, OR 8.3 [IC95% 0,3-38]). El 55% de los pacientes dejaron de utilizar laxantes, enemas o extracción digital. Conclusiones: El uso de IT parece mejorar la calidad de vida en pacientes con estreñimiento e incontinencia de causa orgánica refractaria. La tasa de abandono fue mayor de la esperada, por lo que creemos necesaria la creación de un grupo de apoyo que mejore el seguimiento

Aim of the study: To present our results with transanal irrigation (TAI) for management of fecal incontinence and fecal constipation without response to other treatments. Methods: Retrospective study of patients with fecal constipation and/or fecal incontinence treated with TAI between 2013 and 2017. A Rintala questionnaire(1) was carried out comparing pre and post-treatment results. This study was approved by the ethical committee. Main results: Twenty-five patients were included with a median age of 13 years old (range 6-44 years). Nineteen patients had spinal pathology (76%), four colorectal surgery (16%) and two functional constipation (8%). They presented fecal incontinence in 20% of cases, 12% of fecal constipation and 68% both conditions. After a mean follow-up of 1.5 years (1 month-4 years), 52% of the patients abandoned the treatment. The mean Rintala score was 6.8±4 before treatment, and after, resulted to 11.42±2.75 (p=0.001). The main complications throughout the treatment were pain (68%) and balloon leaks (28%). The patients declared as cause of treatment cessation: reduced mobility (15%), fear or misinformation (32%) and pain (76%). All patients with reduced mobility (n=3) left treatment, versus 45% (n=12) of the patients that had full mobility (p=0.17, OR 8.3 [IC95% 0.3-38]). Complementary treatments such as laxatives, enemas or digital extraction were abandoned in 55% of the patients. Conclusions: Using TAI seems to improve quality of life in patients with fecal constipation and fecal incontinence refractory compared to other treatments. Our abandonment rate was higher than expected, so we believe it is necessary to create a support group to improve follow-ups

Función renal a largo plazo en supervivientes de tumor de Wilms / Long-term renal function in Wilms tumor survivors

Objetivos: Evaluar la función renal y la morbimortalidad a largo plazo, en supervivientes de tumor de Wilms (TW) no sindrómico. Material y métodos: Estudio retrospectivo de pacientes con TW entre 1993-2017 tratados según protocolos SIOP. Evaluamos mortalidad, filtrado glomerular (FG), prevalencia de hipertensión arterial (HTA), necesidad de diálisis y trasplante renal. Se definió enfermedad renal crónica (ERC) como FG <90 ml/min/1,73 m2. Resultados: En los 25 años analizados se trataron 39 pacientes con edad media diagnóstica de 3,6 años (0,3-11 años). Mediana de seguimiento 6 años (0,5-21 años). El 48% (19 pacientes) debutaron con estadio I o II. Cuatro pacientes presentaron histología de alto riesgo (10%). La mortalidad fue del 10%. El 16% (6 pacientes) desarrolló ERC (grados I-II). Ningún paciente precisó terapia renal sustitutoria (TRS) o trasplante. La presencia de ERC tanto en enfermedad unilateral como bilateral fue del 16%, p>0,05; OR 1,04 (IC 95% 0,09-10,9). Se obtuvieron idénticos resultados (16%) comparando pacientes que recibieron radioterapia frente a aquellos que no. Los pacientes en estadio I, II y III presentaron una prevalencia de ERC del 11% vs. 40% en estadio IV (p=0,12); OR 5,3 (IC 95% 0,61-45). Ningún paciente asoció HTA crónica. Conclusiones: En el presente estudio la prevalencia de ERC en supervivientes de TW no sindrómico es baja pero no desdeñable, aunque ninguno precisó trasplante renal o TRS. La presencia de enfermedad bilateral y la radioterapia no se asociaron al desarrollo de ERC. La enfermedad metastásica condiciona un riesgo mayor de ERC

Objetive: To evaluate long-term renal function and morbimortality in non-syndromic Wilms tumor (WT) survivors. Methods: Retrospective study about WT patients treated in 19932017, according to SIOP protocols. Mortality, glomerular filtration rate (GFR), prevalence of hypertension and requirement of dialysis and renal transplant were evaluated. Chronic kidney disease (CKD) was defined as GFR <90 ml/min/1.73 m2. Results: Thirty-nine children were treated in the 25 analyzed years. Median time of follow-up was 6 years (0.5-21 years). 48% (19 patients) debuted with stage I or II. Four cases had high-grade histology. Mortality rate was 10%. GFR data were found in 37 patients. Chronic kidney disease (grade I-II) turned up in 6 patients (16%). No patient required renal replacement therapy or renal transplant. 16% of patients developed CKD in both unilateral and bilateral WT, (p>0.05); OR 1.04 (IC 95% 0.09-10.9). Identical results were obtained comparing patients treated with or without radiotherapy (16%). Children with stage I-III had CKD in 11% vs. 40% of patients with stage IV (p=0.12); OR 5.3 (IC 95% 0.61-45). None of them presented hypertension in addition. Conclusions: In the current study the prevalence of CKD was low but not negligible, although no patients required renal replacement therapy or renal transplant. Bilateral renal involvement and radiotherapy were not associated with CKD development. Metastatic disease determines a higher risk of CKD

[Our experience with sirolimus for the treatment of complicated vascular anomalies]. / Nuestra experiencia con la utilización de sirolimus en el tratamiento de anomalías vasculares complejas.

AIM OF THE STUDY: mTOR inhibitors are being used to treat complex vascular anomalies (VA) without response to conventional treatments. We report our results in pediatric patients treated with sirolimus. METHODS: Retrospective review of patients treated with sirolimus between 2014 and 2017, analyzing vascular anomaly type, treatment response and complications. Treatment protocol included patients with complex vascular anomalies, after signing the informed consent. The initial dose was 0.8 mg/m2/12 h, verifying plasmatic levels. Favorable response was defined both in clinical and radiological terms. MAIN RESULTS: Sirolimus was employed in nine patients, median age 14 months old (1 month-14 years), 66% girls. Five complex micro-cystic lymphatic malformations (LM), one multifocal lynphangioendotheliomatosis with thrombocytopenia, one kaposiform lymphangiomatosis, one lymphatic-venous malformation and one kaposiform hemangioendothelioma (KHE) were treated. Median treatment was 4 months (IQR 2-18 months). Resolution or improvement was objectified in four patients (44%). KHE patient presented complete resolution after two months of treatment. Two patients with micro-cystic LM and the one with lymphatic-venous malformation improved after a median treatment of three months. Two patients presented rebound effect after discontinuing treatment. Three patients had hypertransaminasemia and hypercholesterolemia without requiring medical treatment. CONCLUSION: Sirolimus presented mild effects for treatment of complex VA in our study, but was highly resolutive at KHE.

OBJETIVOS: Los inhibidores mTOR se están utilizando para el tratamiento de anomalías vasculares (AV) complejas sin respuesta a tratamientos convencionales. Presentamos nuestros resultados en pacientes pediátricos tratados con sirolimus. METODOS: Análisis retrospectivo de pacientes tratados con Sirolimus, entre 2014 y 2017, describiendo el tipo de anomalía vascular, respuesta al tratamiento y complicaciones derivadas de su empleo. Se incluyeron pacientes con anomalías vasculares complejas, tras firma del consentimiento informado y con dosis inicial de 0,8 mg/m2/12 horas, monitorizando niveles plasmáticos. Se definió respuesta favorable tanto en términos clínicos como radiológicos. RESULTADOS: Recibieron sirolimus 9 pacientes, mediana de edad de 14 meses (RIQ: 1 mes-14 años). El 66% fueron niñas. Se trataron 5 malformaciones linfáticas (ML) microquísticas complejas (en algunas como coadyuvante a otros tratamientos), 1 linfangioendoteliomatosis multifocal con trombopenia, 1 linfangiomatosis kaposiforme, 1 malformación mixta veno-linfática, 1 hemangioendotelioma kaposiforme (HEK). Mediana de tratamiento: 4 meses (2-18 meses). En 6 pacientes (66%) se objetivó resolución o mejoría de las lesiones. El paciente con HEK mostró resolución completa tras 2 meses de tratamiento. En dos pacientes con ML microquística y en el paciente con malformación mixta, se apreció mejoría clínica y disminución del tamaño de las lesiones tras una mediana de tratamiento de 3 meses. Se apreció efecto rebote en dos ML al suspender el tratamiento. Tres pacientes presentaron hipertransaminasemia e hipercolesterolemia, sin precisar tratamiento médico. CONCLUSIONES: En nuestro estudio, objetivamos que el sirolimus tuvo una eficacia moderada en el tratamiento de AV complejas, pero fue resolutivo en el HEK.

Nuestra experiencia con la utilización de sirolimus en el tratamiento de anomalías vasculares complejas / Our experience with sirolimus for the treatment of complicated vascular anomalies

Objetivos: Los inhibidores mTOR se están utilizando para el tratamiento de anomalías vasculares (AV) complejas sin respuesta a tratamientos convencionales. Presentamos nuestros resultados en pacientes pediátricos tratados con sirolimus. Métodos: Análisis retrospectivo de pacientes tratados con Sirolimus, entre 2014 y 2017, describiendo el tipo de anomalía vascular, respuesta al tratamiento y complicaciones derivadas de su empleo. Se incluyeron pacientes con anomalías vasculares complejas, tras firma del consentimiento informado y con dosis inicial de 0,8 mg/m2/12 horas, monitorizando niveles plasmáticos. Se definió respuesta favorable tanto en términos clínicos como radiológicos. Resultados: Recibieron sirolimus 9 pacientes, mediana de edad de 14 meses (RIQ: 1 mes-14 años). El 66% fueron niñas. Se trataron 5 malformaciones linfáticas (ML) microquísticas complejas (en algunas como coadyuvante a otros tratamientos), 1 linfangioendoteliomatosis multifocal con trombopenia, 1 linfangiomatosis kaposiforme, 1 malformación mixta veno-linfática, 1 hemangioendotelioma kaposiforme (HEK). Mediana de tratamiento: 4 meses (2-18 meses). En 6 pacientes (66%) se objetivó resolución o mejoría de las lesiones. El paciente con HEK mostró resolución completa tras 2 meses de tratamiento. En dos pacientes con ML microquística y en el paciente con malformación mixta, se apreció mejoría clínica y disminución del tamaño de las lesiones tras una mediana de tratamiento de 3 meses. Se apreció efecto rebote en dos ML al suspender el tratamiento. Tres pacientes presentaron hipertransaminasemia e hipercolesterolemia, sin precisar tratamiento médico. Conclusiones: En nuestro estudio, objetivamos que el sirolimus tuvo una eficacia moderada en el tratamiento de AV complejas, pero fue resolutivo en el HEK

Aim of the study: mTOR inhibitors are being used to treat complex vascular anomalies (VA) without response to conventional treatments. We report our results in pediatric patients treated with sirolimus. Methods: Retrospective review of patients treated with sirolimus between 2014 and 2017, analyzing vascular anomaly type, treatment response and complications. Treatment protocol included patients with complex vascular anomalies, after signing the informed consent. The initial dose was 0.8 mg/m2/12 h, verifying plasmatic levels. Favorable response was defined both in clinical and radiological terms. Main results: Sirolimus was employed in nine patients, median age 14 months old (1 month-14 years), 66% girls. Five complex microcystic lymphatic malformations (LM), one multifocal lynphangioendotheliomatosis with thrombocytopenia, one kaposiform lymphangiomatosis, one lymphatic-venous malformation and one kaposiform hemangioendothelioma (KHE) were treated. Median treatment was 4 months (IQR 2-18 months). Resolution or improvement was objectified in four patients (44%). KHE patient presented complete resolution after two months of treatment. Two patients with micro-cystic LM and the one with lymphatic-venous malformation improved after a median treatment of three months. Two patients presented rebound effect after discontinuing treatment. Three patients had hypertransaminasemia and hypercholesterolemia without requiring medical treatment. Conclusion: Sirolimus presented mild effects for treatment of complex VA in our study, but was highly resolutive at KHE

A Na+ conducting hydrogel for protection of organic electrochemical transistors.

Organic electrochemical transistors (OECTs) are being intensively developed for applications in electronics and biological interfacing. These devices rely on ions injected in a polymer film from an aqueous liquid electrolyte for their operation. However, the development of solid or semi-solid electrolytes are needed for future integration of OECTs into flexible, printed or conformable bioelectronic devices. Here, we present a new polyethylene glycol hydrogel with high Na+ conductivity which is particularly suitable for OECTs. This novel hydrogel was synthesized using cost-effective photopolymerization of poly(ethylene glycol)-dimethacrylate and sodium acrylate. Due to the high water content (83% w/w) and the presence of free Na+, the hydrogel showed high ionic conductivity values at room temperature (10-2 S cm-1) as characterized by electrochemical impedance spectroscopy. OECTs made using this hydrogel as a source of ions showed performance that was equivalent to that of OECTs employing a liquid electrolyte. They also showed improved stability, with only a 3% drop in current after 6 h of operation. This hydrogel paves the way for the replacement of liquid electrolytes in high performance OECTs bringing about advantages in terms of device integration and protection.

[Prevention of the wound infection: little changes, huge results]. / Resultados de la modificación de la actitud ante la asepsia en cirugía neonatal: pequeños cambios, grandes resultados.

INTRODUCTION: Neonatal surgical wound infection occurs in almost 50% of neonatal procedures. It increases the rates of morbimortality in neonatal units. There is no guidelines about prevention of wound infection in neonatal surgery. We present our results after changing our behaviour in neonatal surgery. MATERIALS AND METHODS: Comparative study between 2 groups. In order to decrease wound infection at the end of the procedure gloves, covertures and surgical instruments were changed and saline and antiseptic solutions were used during laparotomy closing. Group P included procedures with these recommendations and Group NP without them. Age, weight, surgery, infection, length of stay, and mortality were analized between groups through a logistic regression model. RESULTS: Group P included 55 procedures in 32 patients, median weight 1,300 g (1,000-2,100), 19 median days of life (6-40), 5 postoperative wound problems (9%). Group NP included 26 procedures in 14 neonates, median weight 1,700 g (700-2,500), 20 median days of life (3-33), 14 wound problems (53.8%). We decrease the wound problems in our patients in 44.8% (p < 0.0001). Additionally, the protection provided by our recommendations was maintained after adjustment by weight, age and type of pathology (0.07) p= 0.000. CONCLUSIONS: Simple changes in during the procedures in neonatal surgery can reduce the appearance of wound infection and morbidity.

OBJETIVOS: La infección de herida quirúrgica neonatal tiene una incidencia de hasta el 50% y produce un aumento de morbimortalidad. No existen recomendaciones preventivas consensuadas en la literatura. Presentamos los resultados tras la implantación de un protocolo creado en nuestro Servicio para cierre de laparotomía en cirugía neonatal contaminada y sucia. MATERIAL Y METODOS: Estudio ambispectivo de las laparotomías neonatales realizadas durante 32 meses comparando los resultados con un grupo de pacientes intervenidos durante un período previo similar. El protocolo incluye cambio de guantes, de campo y material quirúrgico, lavado por planos con antiséptico y sutura antibacteriana en el cierre. Se analizan edad, peso, tipo de intervención, infección, estancia hospitalaria y mortalidad y se compara con un grupo similar de pacientes intervenidos de forma previa a la creación del protocolo (NP) y se analiza la influencia del protocolo en la aparición de infección mediante regresión logística. RESULTADOS: El grupo P incluye 55 laparotomías en 32 neonatos con mediana de peso 1.300 g (1.000-2.100), mediana de edad 19 días (6-40) con 3 infecciones de herida (2 cultivos positivos) y 2 dehiscencias leves (9%). El grupo NP incluyó 26 intervenciones en 14 neonatos, mediana de peso 1.700 g (700-2.500), mediana de edad 20 días (3-33), 14 infecciones (53,8%), 8 cultivos positivos y 2 muertes. Se redujo un 44,8% la aparición de infección (p < 0,0001) y el efecto protector del protocolo se mantuvo después del ajuste por peso, edad y tipo de patología (0,07) p= 0,000. CONCLUSIONES: La sencilla modificación de la asepsia y técnica de cierre ha contribuido a disminuir considerablemente la tasa de infección y morbimortalidad en nuestros pacientes y consideramos que es necesario hacer conciencia de ello.

[Long-term results of hypospadias surgery. Urinary and sexual function, and psychological impact]. / Resultados a largo plazo de la cirugía de hipospadias. Función urinaria, sexual e impacto psicológico.

OBJECTIVES: To determine the current status of the patients operated on for hypospadias in our region, in order to adapt the surgical technique to their real needs. MATERIAL AND METHODS: A descriptive and observational study. Interviews were conducted with hypospadias surgery patients in our hospital between 1976 and 1996, focusing on their urinary and sexual function and psychological impact. We performed a descriptive statistical analysis and comparisons between types of hypospadias (SPSSv19). RESULTS: 566 patients were operated on for hypospadias during the study period, interviewing 100 aged between 18 and 40 years. The 73% were distal and 27% proximal. Of all patients, 30% do not have an orthotopic meatus, 10% have fistula, 18% have some degree of stenosis and 52% have penile curvature. The 13% feel to have had disadvantages in their life. They consider they have a different penis in: size (19%), glans shape (17%), curvature (14%), scars (10%) and lowest hole (7%). Sexual satisfaction was valued at 8.9 on a scale of 1 to 10, with no differences between the types of hypospadias. Proximal hypospadias patients have more ejaculation problems: 42% versus 11% in distal hypospadias. The 68% of the proximal ones would like to improve compared to 20% of the distal in: appearance (17%), size (11%) and way to urinate (11%). CONCLUSIONS: Anatomic abnormalities are maintained but the aspects that values the adult patient differ from those persecuted by practiced surgeries. A significant percentage of patients would try to get another surgery. Keeping the size of the penis and natural appearance of the glans should be a priority in hypospadias surgery.

OBJETIVOS: Conocer el estado actual de los pacientes intervenidos por hipospadias en nuestra región, para adaptar la técnica quirúrgica a sus necesidades reales. MATERIAL Y METODOS: Estudio descriptivo y observacional. Se entrevistó a pacientes intervenidos de hipospadias en nuestro hospital entre 1976 y 1996, incidiendo en su función urinaria, sexual e impacto psicológico. Realizamos análisis estadístico descriptivo y comparaciones entre tipos de hipospadias (SPSSv19). RESULTADOS: 566 pacientes fueron intervenidos de hipospadias en el período estudiado, entrevistándose a 100, con edades entre 18 y 40 años. El 73% fueron distales y 27% proximales. En el 30% el meato no es ortotópico, 10% presenta fístula, 18% presenta algún grado de estenosis y 52% presenta curvatura. El 13% siente haber tenido desventajas en su vida. Consideran su pene diferente en: tamaño (19%), forma glande (17%), curvatura (14%), cicatrices (10%) y orificio más bajo (7%). La satisfacción sexual fue valorada en 8,9 en una escala del 1 al 10, sin diferencias entre los tipos de hipospadias. Los proximales presentan mayores problemas de eyaculación: 42% frente al 11% de los distales. El 68% de los proximales desearían mejorar frente al 20% de los distales, en apariencia (17%), tamaño (11%) y forma de orinar (11%). CONCLUSIONES: Se mantienen alteraciones anatómicas pero los aspectos que más valora el paciente adulto difieren de los perseguidos en las cirugías que se practicaban. Un porcentaje importante de pacientes se reoperaría de nuevo. Mantener el tamaño del pene y aspecto natural del glande debe ser un objetivo prioritario durante la cirugía de hipospadias.

Resultados de la modificación de la actitud ante la asepsia en cirugía neonatal: pequeños cambios, grandes resultados / Prevention of the wound infection: little changes, huge results

Objetivos. La infección de herida quirúrgica neonatal tiene una incidencia de hasta el 50% y produce un aumento de morbimortalidad. No existen recomendaciones preventivas consensuadas en la literatura. Presentamos los resultados tras la implantación de un protocolo creado en nuestro Servicio para cierre de laparotomía en cirugía neonatal contaminada y sucia. Material y métodos. Estudio ambispectivo de las laparotomías neonatales realizadas durante 32 meses comparando los resultados con un grupo de pacientes intervenidos durante un período previo similar. El protocolo incluye cambio de guantes, de campo y material quirúrgico, lavado por planos con antiséptico y sutura antibacteriana en el cierre. Se analizan edad, peso, tipo de intervención, infección, estancia hospitalaria y mortalidad y se compara con un grupo similar de pacientes intervenidos de forma previa a la creación del protocolo (NP) y se analiza la influencia del protocolo en la aparición de infección mediante regresión logística. Resultados. El grupo P incluye 55 laparotomías en 32 neonatos con mediana de peso 1.300 g (1.000-2.100), mediana de edad 19 días (6-40) con 3 infecciones de herida (2 cultivos positivos) y 2 dehiscencias leves (9%). El grupo NP incluyó 26 intervenciones en 14 neonatos, mediana de peso 1.700 g (700-2.500), mediana de edad 20 días (3-33), 14 infecciones (53,8%), 8 cultivos positivos y 2 muertes. Se redujo un 44,8% la aparición de infección (p< 0,0001) y el efecto protector del protocolo se mantuvo después del ajuste por peso, edad y tipo de patología (0,07) p= 0,000. Conclusiones. La sencilla modificación de la asepsia y técnica de cierre ha contribuido a disminuir considerablemente la tasa de infección y morbimortalidad en nuestros pacientes y consideramos que es necesario hacer conciencia de ello (AU)

Introduction. Neonatal surgical wound infection occurs in almost 50% of neonatal procedures. It increases the rates of morbimortality in neonatal units. There is no guidelines about prevention of wound infection in neonatal surgery. We present our results after changing our behaviour in neonatal surgery. Materials and methods. Comparative study between 2 groups. In order to decrease wound infection at the end of the procedure gloves, covertures and surgical instruments were changed and saline and antiseptic solutions were used during laparotomy closing. Group P included procedures with these recommendations and Group NP without them. Age, weight, surgery, infection, length of stay, and mortality were analized between groups through a logistic regression model. Results. Group P included 55 procedures in 32 patients, median weight 1,300 g (1,000-2,100), 19 median days of life (6-40), 5 postoperative wound problems (9%). Group NP included 26 procedures in 14 neonates, median weight 1,700 g (700-2,500), 20 median days of life (3-33), 14 wound problems (53.8%). We decrease the wound problems in our patients in 44.8% (p< 0.0001). Additionally, the protection provided by our recommendations was maintained after adjustment by weight, age and type of pathology (0.07) p= 0.000. Conclusions. Simple changes in during the procedures in neonatal surgery can reduce the appearance of wound infection and morbidity (AU)

Resultados a largo plazo de la cirugía de hipospadias. Función urinaria, sexual e impacto psicológico / Hypospadias: results and psychological alterations

Objetivos. Conocer el estado actual de los pacientes intervenidos por hipospadias en nuestra región, para adaptar la técnica quirúrgica a sus necesidades reales. Material y métodos. Estudio descriptivo y observacional. Se entrevistó a pacientes intervenidos de hipospadias en nuestro hospital entre 1976 y 1996, incidiendo en su función urinaria, sexual e impacto psi- cológico. Realizamos análisis estadístico descriptivo y comparaciones entre tipos de hipospadias (SPSSv19). Resultados. 566 pacientes fueron intervenidos de hipospadias en el período estudiado, entrevistándose a 100, con edades entre 18 y 40 años. El 73% fueron distales y 27% proximales. En el 30% el meato no es ortotópico, 10% presenta fístula, 18% presenta algún grado de estenosis y 52% presenta curvatura. El 13% siente haber tenido desventajas en su vida. Consideran su pene diferente en: tamaño (19%), forma glande (17%), curvatura (14%), cicatrices (10%) y orificio más bajo (7%). La satisfacción sexual fue valorada en 8,9 en una escala del 1 al 10, sin diferencias entre los tipos de hipospadias. Los proximales presentan mayores problemas de eyaculación: 42% frente al 11% de los distales. El 68% de los proximales desearían mejorar frente al 20% de los distales, en apariencia (17%), tamaño (11%) y forma de orinar (11%). Conclusiones. Se mantienen alteraciones anatómicas pero los aspectos que más valora el paciente adulto difieren de los perseguidos en las cirugías que se practicaban. Un porcentaje importante de pacientes se reoperaría de nuevo. Mantener el tamaño del pene y aspecto natural del glande debe ser un objetivo prioritario durante la cirugía de hipospadias (AU)

Objectives. To determine the current status of the patients operated on for hypospadias in our region, in order to adapt the surgical technique to their real needs. Material and methods. A descriptive and observational study. Interviews were conducted with hypospadias surgery patients in our hospital between 1976 and 1996, focusing on their urinary and sexual function and psychological impact. We performed a descriptive statistical analysis and comparisons between types of hypospadias (SPSSv19). Results. 566 patients were operated on for hypospadias during the study period, interviewing 100 aged between 18 and 40 years. The 73% were distal and 27% proximal. Of all patients, 30% do not have an orthotopic meatus, 10% have fistula, 18% have some degree of stenosis and 52% have penile curvature. The 13% feel to have had disadvantages in their life. They consider they have a different penis in: size (19%), glans shape (17%), curvature (14%), scars (10%) and lowest hole (7%). Sexual satisfaction was valued at 8.9 on a scale of 1 to 10, with no differences between the types of hypospadias. Proximal hypospadias patients have more ejaculation problems: 42% versus 11% in distal hypospadias. The 68% of the proximal ones would like to improve compared to 20% of the distal in: appearance (17%), size (11%) and way to urinate (11%). Conclusions. Anatomic abnormalities are maintained but the aspects that values the adult patient differ from those persecuted by practiced surgeries. A significant percentage of patients would try to get another surgery. Keeping the size of the penis and natural appearance of the glans should be a priority in hypospadias surgery (AU)