[Open surgery, laparoscopic Palomo varicocelectomy and embolization in children with varicocele]. / Cirugía abierta, Palomo laparoscópico y embolización en niños con varicocele.

OBJECTIVES: Our aim was to prove the outcomes in varicocele treatment during last 10 years in our institution regarding to the recurrence rate and reactive hydrocele in children and adolescents treated with open technique, laparoscopic approach or embolization. PATIENTS AND METHODS: Medical charts of patients with varicocele younger than 17 years old were reviewed. Age, weight, surgery indications, treatment (open surgery, laparoscopic Palomo varicocelectomy or embolization), location, varicocele grade, hospital stays, recurrence, postoperative hydrocele, genitofemoral nerve damage, infection, bleeding, postoperative incisional hernia and re-do varicocelectomy were collected. RESULTS: From 2000 to 2010, 98 boys with varicocele diagnosis were treated in our institution. Mean age of patients was 12 years. The varicocele location in all cases was on the left side. Grade III varicocele was found in 94 boys and grade II in 4 patients. Indications for surgery were high grade in 81, chronic pain in 16 and testicular hypotrophy in 1. Treatment approach was as follows: 12 patients underwent open surgery (Palomo or Ivanissevich technique), 32 underwent embolization and laparoscopic Palomo varicocelectomy was performed in 54. We found a global recurrence rate of 14.3% and an overall postoperative hydrocele of 24.5% Recurrence rate was higher in the embolization group than the open surgery and laparoscopic group. Three patients presented intraoperative bleeding in the laparoscopic group and there was one conversion to open surgery. CONCLUSIONS: Our retrospective review proves that laparoscopic Palomo varicocelectomy is a safe and efficient approach to treat varicocele in pediatric population, because of its low recurrence rate without any major adverse outcome. Due to our high secondary hydrocele formation, lymphatic sparing laparoscopic procedure should be taken into account in order to decrease this complication.

Cirugía abierta, Palomo laparoscópico y embolización en niños con varicocele / Open surgery, laparoscopic Palomo varicocelectomy and embolization in children with varicocele

Objetivos. El objetivo del presente estudio es examinar los resultados en el tratamiento del varicocele en nuestro hospital durante los últimos 10 años, valorando la de tasa de recurrencia y de hidrocele reactivo en los niños y adolescentes tratados mediante cirugía abierta, embolización o varicocelectomía laparoscópica. Pacientes y métodos. Se revisaron las historias clínicas de los pacientes menores de 17 años intervenidos de varicocelectomía. Las variables recogidas fueron peso, edad, localización, grado de varicocele, indicación de cirugía, tratamiento, estancia hospitalaria, recurrencia, hidrocele postoperatorio, lesión de nervio genitofemoral, infección, sangrado, hernia incisional y necesidad de nueva varicocelectomía. Resultados. 98 pacientes con diagnóstico de varicocele fueron tratados en nuestra institución entre los años 2000 a 2010. La edad media fue de 12 años. Todos los casos fueron de localización izquierda. 94 pacientes tenían varicocele grado III y 4 varicocele grado II. Las indicaciones de cirugía fueron varicocele de alto grado (grado III) en 81 pacientes, dolor crónico en 16 e hipotrofia testicular en 1. Se realizó cirugía abierta en 12 pacientes, embolización en 32 casos y varicocelectomía laparoscópica en 54 pacientes. La tasa global de recurrencia fue de 14,3% y el porcentaje de hidrocele reactivo fue del 24,5% La tasa de recurrencia fue mayor en el grupo tratado con embolización, que en el de cirugía abierta y en el de laparoscopia. En el grupo de tratamiento laparoscópico, tres pacientes presentaron sangrado postquirúrgico y hubo una conversión a cirugía abierta. Conclusiones. Nuestra revisión retrospectiva indica que la varicocelectomía laparoscópica es un tratamiento seguro y eficaz en el manejo del varicocele en los (..) (AU)

Objectives. Our aim was to prove the outcomes in varicocele treatment during last 10 years in our institution regarding to the recurrence rate and reactive hydrocele in children and adolescents treated with open technique, laparoscopic approach or embolization. Patients and Methods. Medical charts of patients with varicocele younger than 17 years old were reviewed. Age, weight, surgery indications, treatment (open surgery, laparoscopic Palomo varicocelectomy or embolization), location, varicocele grade, hospital stays, recurrence, postoperative hydrocele, genitofemoral nerve damage, infection, bleeding, postoperative incisional hernia and re-do varicocelectomy were collected. Results. From 2000 to 2010, 98 boys with varicocele diagnosis were treated in our institution. Mean age of patients was 12 years. The varicocele location in all cases was on the left side. Grade III varicocele was found in 94 boys and grade II in 4 patients. Indications for surgery were high grade in 81, chronic pain in 16 and testicular hypotrophy in 1. Treatment approach was as follows: 12 patients underwent open surgery (Palomo or Ivanissevich technique), 32 underwent embolization and laparoscopic Palomo varicocelectomy was performed in 54. We found a global recurrence rate of 14.3% and an overall postoperative hydrocele of 24.5% Recurrence rate was higher in the embolization group than the open surgery and laparoscopic group. Three patients presented intraoperative bleeding in the laparoscopic group and there was one conversion to open surgery. Conclusions. Our retrospective review proves that laparoscopic Palomo varicocelectomy is a safe and efficient approach to treat varicocele in pediatric population, because of its low recurrence rate without any major adverse outcome. Due to our high secondary hydrocele formation, lymphatic sparing laparoscopic procedure should be taken into account in order to decrease this complication (AU)

Alteraciones estructurales del músculo liso y de la expresión de EGFR y C-kit en la estenosispieloureteral congénita. Relación con su patogénesis / Structural alterations of the smooth muscle and of the egfr expression and c-kit in congenital pyelouretheral stenosis. relationship with its pathogenesis

Objetivos. Evaluar el papel que la displasia muscular, el factor de crecimiento epidérmico (EGFR) y las células intersticiales de Cajal(CIC) C-kit+ pueden tener en la fisiopatología de la estenosis pieloureteral (EPU).Material y Método. Se estudian 30 muestras de UPU (unión pieloureteral), 25 con EPU y 5 controles. Se realizan tinciones con Tricrómico de Masson y técnicas de inmunohistoquímica para Actina de músculo liso, EGFR (factor de crecimiento epidérmico) y CD117(C-kit)(Dako). Comparamos los resultados estadísticamente Resultados. El grupo control expresó positividad difusa de EGFR en la capa muscular; en las muestras de EPU fue positiva en el 4%, débil en el 16% y negativa en el 80%. Los controles muestran CIC C-kit+entre las células musculares, evidenciándose una densidad disminuida en las muestras de obstrucción. El tricrómico de Masson resaltó aumento del colágeno inter e intramuscular y fibras musculares atenuadas, más finas e individualizadas, en la capa muscular interna de los casos de (..) (AU)

Purpose. To assess the role that the muscular dysplasia, epidermal growth factor (EGFR) and interstitial cells of Cajal (ICC) C-kit +, may have in the pathophysiology of pyeloureteral stenosis (EPU).Materials and Methods. 30 samples were studied UPJ (ureteropelvic junction), with 25 UPJ obstruction and 5 controls. Performed with Masson’s trichrome staining and immunohistochemical techniques for smooth muscle actin, EGFR (epidermal growth factor) and CD117(C-kit) (Dako). We compared the results statistically. Results. The control group was diffuse positivity of EGFR in the muscle layer in samples of EPU was positive in 4%, weak in 16% and negative in 80%. The controls are C-kit + ICC between the muscle cells showed a decreased density in the samples of obstruction. Masson’strichrome highlighted the increase of inter-and intramuscular collagen and attenuated muscle fibers, thinner and individualized, in the inner (..) (AU)

[Structural alterations of the smooth muscle and of the EGFR expression and C-kit in congenital pyeloureteral stenosis. Relationship with its pathogenesis]. / Alteraciones estructurales del músculo liso y de la expresión de EGFR y C-kit en la estenosis pieloureteral congénita. Relación con su patogénesis.

PURPOSE: To assess the role that the muscular dysplasia, epidermal growth factor (EGFR) and interstitial cells of Cajal (ICC) C-kit +, may have in the pathophysiology of pyeloureteral stenosis (EPU). MATERIALS AND METHODS: 30 samples were studied UPJ (ureteropelvic junction), with 25 UPJ obstruction and 5 controls. Performed with Masson's trichrome staining and immunohistochemical techniques for smooth muscle actin, EGFR (epidermal growth factor) and CD117 (C-kit) (Dako). We compared the results statistically. RESULTS: The control group was diffuse positivity of EGFR in the muscle layer in samples of EPU was positive in 4%, weak in 16% and negative in 80%. The controls are C-kit + ICC between the muscle cells showed a decreased density in the samples of obstruction. Masson's trichrome highlighted the increase of inter-and intramuscular collagen and attenuated muscle fibers, thinner and individualized, in the inner muscular layer of the cases of EPU also evident with the actin. Differences between groups were statistically significant (p < 0.001). CONCLUSIONS: Our results suggest that dysplastic changes in the muscle layer, the low expression of EGFR and the decrease or absence of C-kit + ICC, may participate in the pathophysiology of UPJ obstruction.

Low prevalence of complications of delayed herniotomy in the extremely premature infant.

AIM: To study the relationship between the delay of herniotomy in the extremely premature infant and the rate of complications in comparison with full-term children. METHODS: A follow-up study of three groups of neonates operated on for inguinal hernia was performed. The groups were defined as: a) the short-waiting group (SWG): prematures (mean gestational age: 32.56 +/- 0.62; n = 9) operated on within 2 wk of diagnosis (median: 5 d); b) the long-waiting group (LWG): prematures (mean gestational age: 28.38 +/- 1; n = 21) operated on after more than 2 wk (median: 39 d); and c) control group of full-term children (FTG); (mean gestational age: 38.18 +/- 0.29; median of timing: 3 d; n = 11). Several variables (gestational age, weight at birth and at surgery, side of the inguinal herrnia, timing, duration of surgery, type of anaesthesia, length of hospitalization), as well as the occurrence of apnoea, incarceration and testicular atrophy were compared between groups. RESULTS: Timing was the only variable that was different between the LWG and the other two groups (p < 0.001, ANOVA). Seven preoperative episodes of incarceration occurred: one in the SWG, two in the LWG and four in the FTG (p = 0.138, chi2). In the follow-up study two testicular atrophies, related to previous episodes of incarceration, were found: one in the FTG and the other in the SWG (p = 0.221, chi2). CONCLUSION: The deferral of herniotomy in the extremely premature infant, until the child is ready to be discharged from the neonatal unit, does not seem to increase the risk of incarceration episodes or testicular atrophy.