Utilidad clínica de la medición del área máxima del trazado del detrusor en el estudio urodinámico en el paciente pediátrico con vejiga neuropática: estudio piloto / Clinical utility of the maximum area of detrusor tracing measurement in the urodynamic studies in pediatric population diagnosed with neuropathic bladder: A pilot study

IntroducciónLa vejiga neuropática (VN) es una disfunción del tracto urinario inferior (DTUinf) con riesgo de deterioro de la función renal, siendo el estudio urodinámico (EUD) la prueba patrón para su diagnóstico y seguimiento. El parámetro urodinámico clásico para identificar el riesgo renal es la presión de fuga del detrusor>=40 cmH2O, aunque este valor aislado puede carecer de interés pronóstico. Recientemente se ha descrito el área bajo la curva (ABC) del trazado de la presión del detrusor como factor pronóstico.ObjetivoAnalizar la utilidad clínica del ABC del trazado de la presión del detrusor en edad pediátrica (< 15 años).MétodosEstudio retrospectivo de registros urodinámicos en población pediátrica con VN entre 2011-2020. Se registran: presión detrusor y de fuga ≥ 40 cmH2O, alteración de la acomodación, vaciado e hiperactividad detrusor. Se clasifica la muestra según evolución clínica-radiológica en el momento del EUD. Se calcula el ABC utilizando los métodos de Newton-Côtes (trapecios, Simpson compuesto) y se calculan sus índices según la capacidad vesical (índice trapecios [IT]; índice Simpson [IS]). Significación estadística: p<0,05.ResultadosSe analizan 55 registros. El 41,8% (n=23) tuvo una evolución clínica desfavorable. La alteración en el vaciado, la hipoacomodación y los índices se asociaron a una situación clínica desfavorable(p <0,05). El ABC del rendimiento diagnóstico de los nuevos índices fue: IT (0,736, p=0,0006); IS (0,755, p=0,0001). Los puntos de corte del valor de IT e IS fueron de 10,69 y 8 cmH2O×s/cc, respectivamente. No encontramos diferencias en el rendimiento diagnóstico entre ellos (p> 0,05).ConclusionesLos nuevos índices estudiados son útiles en el diagnóstico de pacientes con VN y situación clínica desfavorable (AU)

IntroductionNeuropathic bladder (NB) is a lower urinary tract dysfunction (LUTD) that may lead to kidney failure. Urodynamic study is the gold standard for its diagnosis and follow-up. A classic prognostic parameter to predict the risk of upper urinary tract damage (UUTD) is the detrusor leak point pressure (DLPP)>=40cmH2O, although this factor alone may lack prognostic value. The area under the curve (AUC) of the detrusor pressure tracing has been recently described as a prognostic factor.AimTo analyze the clinical utility of the AUC of the detrusor pressure tracing in the pediatric population (<15 years).MethodsRetrospective study of urodynamic recordings in pediatric population with NB from 2011 to 2020. The following variables were evaluated: detrusor leak point pressure>=40cmH2O, voiding dysfunction, bladder compliance and overactivity. The sample is classified according to clinical-radiological findings at the time of the UD. AUC is calculated using Newton-Cotes rules (trapezium, Simpson's rule) and its indexes are calculated according to bladder capacity (TI: Trapezium Index, SI: Simpson Index). Statistical significance: P<.05.ResultsFifty-five recordings are analyzed. Unfavorable clinical condition was identified in 41.8% (n=23) patients. Voiding dysfunction, low compliance and both indexes were associated with an unfavorable clinical condition (P<.05). ROC analysis showed the following AUC for the new indexes: TI (0.736, P=.0006), SI (0.755, P=.0001) with a cut-off value of 10,69 and 8cmH2Os/cc, respectively. We did not find differences in the diagnostic performance between them (P>.05).ConclusionsThe analyzed indexes are useful in the diagnosis of patients with NB and unfavorable clinical condition (AU)

Clinical utility of the maximum area of detrusor tracing measurement in the urodynamic studies in pediatric population diagnosed with neuropathic bladder: A pilot study.

INTRODUCTION: Neuropathic bladder (NB) is a lower urinary tract dysfunction (LUTD) that may lead to kidney failure. Urodynamic study is the gold standard for its diagnosis and follow-up. A classic prognostic parameter to predict the risk of upper urinary tract damage (UUTD) is the detrusor leak point pressure (DLPP) ≥  40 cmH2O, although this factor alone may lack prognostic value. The area under the curve (AUC) of the detrusor pressure tracing has been recently described as a prognostic factor. AIM: To analyze the clinical utility of the AUC of the detrusor pressure tracing in the pediatric population (<15 years). METHODS: Retrospective study of urodynamic recordings in pediatric population with NB from 2011 to 2020. The following variables were evaluated: detrusor leak point pressure ≥ 40 cmH2O, voiding dysfunction, bladder compliance and overactivity. The sample is classified according to clinical-radiological findings at the time of the UD. AUC is calculated using Newton-Cotes rules (trapezium, Simpson's rule) and its indexes are calculated according to bladder capacity (TI: Trapezium Index, SI: Simpson Index). Statistical significance: P < .05. RESULTS: Fifty-five recordings are analyzed. Unfavorable clinical condition was identified in 41.8% (n = 23) patients. Voiding dysfunction, low compliance and both indexes were associated with an unfavorable clinical condition (P < .05). ROC analysis showed the following AUC for the new indexes: TI (0.736, P = 0.0006), SI (0.755, P = .0001) with a cut-off value of 10,69 and 8 cmH2O·s/cc, respectively. We did not find differences in the diagnostic performance between them (P > .05). CONCLUSIONS: The analyzed indexes are useful in the diagnosis of patients with NB and unfavorable clinical condition.

High-flow priapism in pediatric population: Case series and review of the literature.

INTRODUCTION: Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. PATIENTS AND METHODS: Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. RESULTS: A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. CONCLUSIONS: High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

High-flow Priapism in Pediatric Population: Case Series and Review of the Literature. / Priapismo de alto flujo en población pediátrica: serie de casos y revisión de la literatura.

INTRODUCTION: Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. PATIENTS AND METHODS: Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. RESULTS: A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. CONCLUSIONS: High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

Evaluación de la higiene del sueño y la prevalencia de sus alteraciones en los pacientes con enuresis monosintomática. Utilidad del cuestionario BEARS / Evaluation of sleep hygiene and prevalence of sleep disorders in patients with monosymptomatic enuresis. Usefulness of the BEARS sleep screening tool

OBJETIVOS: Analizar si existe mayor prevalencia de trastornos del sueño y desórdenes en su higiene en los pacientes con enuresis monosintomática (ENM) con respecto a la población general y a los pacientes con ENM corregida. Valorar la utilidad de la escala de cribado de trastornos del sueño en la infancia BEARS en la ENM. MATERIAL Y MÉTODOS: Estudio observacional transversal (n = 341) clasificados en: ENM (n = 122), ENM corregida (> = 1 a un año sin recidiva) (ANTENUR) (n = 47) y controles (n = 172). Se utilizó el cuestionario de cribado de trastornos del sueño en la infancia BEARS. Se recopilaron variables clínicas, así como variables en referencia a la higiene del sueño. Estadísticos: chi cuadrado, t de Student, ANOVA, U Mann-Whitney y Kruskall-Wallis. Significación p < 0,05. RESULTADOS: Media de edad 9,7 ± 3,0 años. No existieron diferencias estadísticamente significativas con respecto a edad, género, IMC, antecedente de amigdalectomía, asma y número de horas de sueño. Con respecto a la higiene del sueño, los pacientes con ENM presentaron mayor porcentaje de alteraciones con respecto a los controles. En cuanto al cuestionario BEARS, demostró mayor prevalencia de alteraciones del sueño en el grupo de pacientes con ENM, con respecto a los otros dos grupos. Un 60,7% (n = 74) frente al 18,6% (n = 32) y el 38,3% (n = 18) de los controles y ANTENUR, respectivamente (p < 0,05). CONCLUSIONES: Los niños con ENM presentaron mayor prevalencia de desórdenes durante el sueño así como en la higiene de este, con respecto a los controles. El cuestionario BEARS es una herramienta clínica útil en la detección de los desórdenes del sueño en el niño

OBJECTIVES: To analyze if there is a higher prevalence of sleep disturbances and hygiene disorders in patients with monosymptomatic enuresis (MEN) with respect to general population and to patients with corrected MEN. Assess the usefulness of the BEARS sleep disorder screening tool for children with MEN. MATERIAL AND METHODS: Transverse observational study (n = 341) classified as: MEN (n = 122), corrected MEN (≥ 1 one year without recurrence) (ANTENUR) (n = 47) and controls (n = 172). The BEARS childhood sleep disorder screening questionnaire was used. Clinical variables were collected, as well as variables related to sleep hygiene. Statistics: Chi-square, Student's t, ANOVA, Mann-Whitney U and Kruskal-Wallis. Significance p < .05. RESULTS: Mean age 9.7 ± 3.0 years. There were no statistically significant differences in terms of age, sex, BMI, history of tonsillectomy, asthma and sleep time hours. With respect to sleep hygiene, patients with MEN presented a higher percentage of alterations than controls. As for the BEARS questionnaire, it showed a higher prevalence of sleep disorders in the group of patients with MEN, with respect to the other two groups: 60.7% (n = 74) versus 18.6% (n = 32) and 38.3% (n = 18) of controls and ANTENUR, respectively (p < .05). CONCLUSIONS: Children with MEN had a higher prevalence of sleep disturbances and sleep disorders than controls. The BEARS questionnaire is a useful clinical tool in the detection of sleep disorders in children

Evaluation of sleep hygiene and prevalence of sleep disorders in patients with monosymptomatic enuresis. Usefulness of the BEARS sleep screening tool. / Evaluación de la higiene del sueño y la prevalencia de sus alteraciones en los pacientes con enuresis monosintomática. Utilidad del cuestionario BEARS.

OBJECTIVES: To analyze if there is a higher prevalence of sleep disturbances and hygiene disorders in patients with monosymptomatic enuresis (MEN) with respect to general population and to patients with corrected MEN. Assess the usefulness of the BEARS sleep disorder screening tool for children with MEN. MATERIAL AND METHODS: Transverse observational study (n=341) classified as: MEN (n=122), corrected MEN (≥ 1 one year without recurrence) (ANTENUR) (n=47) and controls (n=172). The BEARS childhood sleep disorder screening questionnaire was used. Clinical variables were collected, as well as variables related to sleep hygiene. STATISTICS: Chi-square, Student's t, ANOVA, Mann-Whitney U and Kruskal-Wallis. Significance p<.05. RESULTS: Mean age 9.7±3.0 years. There were no statistically significant differences in terms of age, sex, BMI, history of tonsillectomy, asthma and sleep time hours. With respect to sleep hygiene, patients with MEN presented a higher percentage of alterations than controls. As for the BEARS questionnaire, it showed a higher prevalence of sleep disorders in the group of patients with MEN, with respect to the other two groups: 60.7% (n=74) versus 18.6% (n=32) and 38.3% (n=18) of controls and ANTENUR, respectively (p<.05). CONCLUSIONS: Children with MEN had a higher prevalence of sleep disturbances and sleep disorders than controls. The BEARS questionnaire is a useful clinical tool in the detection of sleep disorders in children.

Spontaneous spermatic vein thrombosis in pediatric patients: A condition to be considered. / Trombosis espontánea de la vena espermática en la edad pediátrica: una entidad a tener en cuenta.

Spermatic vein thrombosis is a very rare pathology, with 25 cases published only, 6 of which in patients under 15 years of age. We present the case of a male patient, as well as a review of the literature. A 12-year old boy presented at emergency with 3-day progressive testicular pain. Following abdominal Doppler ultrasound imaging, he was diagnosed with left spermatic vein thrombosis and nutcracker syndrome. Admission and enoxaparin treatment were decided upon. Patient evolution was satisfactory, with subsequent ultrasound imaging demonstrating the absence of thrombus. The patient is currently under follow-up and without treatment. Various treatments are mentioned in the literature, with conservative management being the treatment of choice.

La trombosis de la vena espermática es una patología muy poco frecuente, con solo 25 casos publicados, 6 de los cuales menores de 15 años. De esta manera presentamos el caso de un varón, así como la revisión de la literatura. Un paciente de 12 años de edad acudió a Urgencias por dolor testicular de aumento progresivo, de 3 días de evolución. Mediante ecografía doppler abdominal se diagnosticó de trombosis de la vena espermática izquierda y síndrome de cascanueces. Se decidió ingreso y tratamiento con enoxaparina. La evolución del paciente fue satisfactoria, en la ecografía posterior se observó la desaparición del trombo. El paciente se encuentra en seguimiento y sin tratamiento. Existen varios tratamientos reflejados en la literatura, siendo el de elección el manejo conservador.

Trombosis espontánea de la vena espermática en la edad pediátrica: una entidad a tener en cuenta / Spontaneous spermatic vein thrombosis in pediatric patients: A condition to be considered

La trombosis de la vena espermática es una patología muy poco frecuente, con solo 25 casos publicados, 6 de los cuales menores de 15 años. De esta manera presentamos el caso de un varón, así como la revisión de la literatura. Un paciente de 12 años de edad acudió a Urgencias por dolor testicular de aumento progresivo, de 3 días de evolución. Mediante ecografía doppler abdominal se diagnosticó de trombosis de la vena espermática izquierda y síndrome de cascanueces. Se decidió ingreso y tratamiento con enoxaparina. La evolución del paciente fue satisfactoria, en la ecografía posterior se observó la desaparición del trombo. El paciente se encuentra en seguimiento y sin tratamiento. Existen varios tratamientos reflejados en la literatura, siendo el de elección el manejo conservador

Spermatic vein thrombosis is a very rare pathology, with 25 cases published only, 6 of which in patients under 15 years of age. We present the case of a male patient, as well as a review of the literature.A 12-year old boy presented at emergency with 3-day progressive testicular pain. Following abdominal Doppler ultrasound imaging, he was diagnosed with left spermatic vein thrombosis and nutcracker syndrome. Admission and enoxaparin treatment were decided upon. Patient evolution was satisfactory, with subsequent ultrasound imaging demonstrating the absence of thrombus. The patient is currently under follow-up and without treatment. Various treatments are mentioned in the literature, with conservative management being the treatment of choice

Utilidad de la clasificación de los patrones de disfunción miccional en el pronóstico del primer tratamiento endoscópico del reflujo vesicoureteral en niños mayores de 3 años / Usefulness of the classification of urinary dysfunction for the prognosis of the first endoscopic treatment of vesicoureteral reflux in children over the age of 3

Objetivos: Valorar el rendimiento diagnóstico de los patrones de micción disfuncional asociados al reflujo vesicoureteral (RVU) en niños mayores de 3 años, en función del resultado del primer tratamiento endoscópico (T1END), agrupados en una clasificación diseñada por nuestro grupo (CMD.URI-La Fe) y su comparación con otras clasificaciones existentes como la de Van Batavia et al. Material y métodos: Estudio transversal ambispectivo de una muestra de 50 niños. Criterios de exclusión: TEND previo, edad ≤ 3 años, anomalías anatómicas o neurológicas y antecedentes de cirugía uretral o abdominopélvica. Previamente al T1END se realizó una valoración de la función de vaciado vesical mediante flujometría + electromiografía (UF-EMG) y del residuo posmiccional (ecografía). Se obtuvieron otras variables procedentes del diario miccional, el espesor de la pared vesical premiccional (ecografía), así como variables clínicas. La corrección del RVU fue valorada mediante cistografía isotópica a los 3 meses del tratamiento. Se realizó una clasificación de los patrones miccionales en función de las variables significativas (URI-La Fe) y se valoró su rendimiento diagnóstico, comparándola al clasificar a los pacientes según propone Van Batavia et al. Resultados: Media de edad: 6,8 ± 2,28 años. Varones/mujeres (44%/56%). Grados de RVU: leve, moderado, severo. Tasa de corrección del RVU T1END: 77% (n = 38). Rendimiento diagnóstico (Van Batavia; URI-La Fe): predicción correcta (37,5%; 75%), sensibilidad (32,4%; 87,8%), especificidad (54,5%; 46,6%), valor predictivo positivo (70,6; 78,3%) y valor predictivo negativo (19,4%; 63,6%). Conclusiones: Nuestros resultados muestran la utilidad del estudio no invasivo y la clasificación de la disfunción miccional del niño mayor de 3 años previo al primer tratamiento endoscópico del RVU

Objectives: To assess the diagnostic performance of urinary dysfunction patterns associated with vesicoureteral reflux (VUR) in children over the age of 3 according to the result of the first endoscopic treatment (ENDT1), grouped into a classification designed by our group (CMD.URI-La Fe). Comparison with other current classifications such as that of Van Batavia et al. Material and methods: Ambispective cross-cutting study of a sample of 50 children. Exclusion criteria: previous ENDT, age ≤ 3 years, anatomical or neurological anomalies and a history of ureteral or abdominopelvic surgery. Prior to the ENDT1, a bladder voiding function assessment by uroflowmetry+electromyography (UF-EMG) and post-mictional residue (ultrasound). Other variables from the bladder diary, pre-mictional bladder wall thickness and other clinical variables. The correction of VUR was assessed by isotope cystography 3 months after the treatment. Urinary patterns were classified according to the significant variables (URI-La Fe), and the diagnostic performance of this classification was assessed, comparing it to the classification of patients as proposed by Van Batavia et al. Results: Mean age: 6.8±2.28 years. Males/females (44%/56%). Grades of VUR (mild/moderate/severe). ENDT1 VUR correction rate: 77% (n=38). Diagnostic performance (Van Batavia; URI-La Fe): correct prediction (37.5%; 75%), sensitivity (32.4%; 87.8%), specificity (54.5%; 46.6%), positive predictive value (70.6; 78.3%) and negative predictive value (19.4%; 63.6%). Conclusions: Our results show the usefulness of the non-invasive test and the classification of urinary dysfunction in children aged over 3 years prior to the first endoscopic treatment of VUR

Usefulness of the classification of urinary dysfunction for the prognosis of the first endoscopic treatment of vesicoureteral reflux in children over the age of 3. / Utilidad de la clasificación de los patrones de disfunción miccional en el pronóstico del primer tratamiento endoscópico del reflujo vesicoureteral en niños mayores de 3 años.

OBJECTIVES: To assess the diagnostic performance of urinary dysfunction patterns associated with vesicoureteral reflux (VUR) in children over the age of 3 according to the result of the first endoscopic treatment (ENDT1), grouped into a classification designed by our group (CMD.URI-La Fe). Comparison with other current classifications such as that of Van Batavia et al. MATERIAL AND METHODS: Ambispective cross-cutting study of a sample of 50 children. EXCLUSION CRITERIA: previous ENDT, age ≤ 3 years, anatomical or neurological anomalies and a history of ureteral or abdominopelvic surgery. Prior to the ENDT1, a bladder voiding function assessment by uroflowmetry+electromyography (UF-EMG) and post-mictional residue (ultrasound). Other variables from the bladder diary, pre-mictional bladder wall thickness and other clinical variables. The correction of VUR was assessed by isotope cystography 3 months after the treatment. Urinary patterns were classified according to the significant variables (URI-La Fe), and the diagnostic performance of this classification was assessed, comparing it to the classification of patients as proposed by Van Batavia et al. RESULTS: Mean age: 6.8±2.28 years. Males/females (44%/56%). Grades of VUR (mild/moderate/severe). ENDT1 VUR correction rate: 77% (n=38). Diagnostic performance (Van Batavia; URI-La Fe): correct prediction (37.5%; 75%), sensitivity (32.4%; 87.8%), specificity (54.5%; 46.6%), positive predictive value (70.6; 78.3%) and negative predictive value (19.4%; 63.6%). CONCLUSIONS: Our results show the usefulness of the non-invasive test and the classification of urinary dysfunction in children aged over 3 years prior to the first endoscopic treatment of VUR.

[Experience in the conservative treatment of renal trauma]. / Experiencia en el tratamiento conservador del traumatismo renal.

OBJECTIVE: The management of renal trauma has been changing in recent years so that nowadays, even in high grades, an initial conservative treatment is advocated. The aim of this work is to review the presentation, initial attitude and evolution of the renal traumas treated in our institution. MATERIAL AND METHODS: Retrospective review of patients with renal trauma treated at our institution in the last 10 years. Epidemiological variables, production mechanism, pediatric trauma index (PTI), treatment and evolution were analyzed. RESULTS: We studied 26 patients, 18 men (69.3%). The most frequent mechanism was the direct hit in 11 patients (42.31%). The most frequently side affected was the right one in 14 patients (53.85%). The grade III traumatism according to American Association for the surgery of Trauma (AAST) was the most repeated, 11 patients (42.31%). Nine patients (44.55%) presented concomitant injuries in other solid organs. In 24 patients (92.30%) the initial treatment was conservative with supportive measures. One patient presented with hemodynamic instability and an urgent intervention was conducted, performing a supraselective embolization with immediate control of the active bleeding. In another patient, a double J catheter was placed due to disruption of the excretory tract. Of the patients treated conservatively initially, only one patient (4.1%) required secondary surgical maneuvers due to a complication. CONCLUSIONS: In patients with renal trauma, non-surgical treatment is safe and effective. In case of hemodynamic instability or complication, interventional radiological techniques have been demonstrated to be safe and effective in the pediatric population.

OBJETIVO: El manejo del traumatismo renal ha ido variando en los últimos años de modo que en la actualidad, incluso en los grados altos, se aboga por un tratamiento inicial conservador. El objetivo de este trabajo es revisar la presentación, actitud inicial y evolución de los traumatismos renales atendidos en nuestra institución. MATERIAL Y METODOS: Revisión retrospectiva de pacientes con traumatismo renal atendidos en los últimos 10 años. Se analizaron las variables epidemiológicas, mecanismo de producción, índice de trauma pediátrico (ITP), tratamiento y evolución. RESULTADOS: Se estudiaron 26 pacientes, 18 varones (69,23%). La causa más frecuente fue el golpe directo en 11 pacientes (42,31%). El lado más frecuentemente afectado fue el derecho en 14 pacientes (53,85%). El traumatismo grado III según la American Association for the Surgery of Trauma (AAST) fue el más común, 11 pacientes (42,31%). Nueve pacientes (44,55%) presentaron lesiones concomitantes en otros órganos sólidos. En 24 pacientes (92,30%) el tratamiento inicial fue conservador con medidas de soporte. Un paciente se presentó con inestabilidad hemodinámica y se intervino de forma urgente realizándose embolización supraselectiva con control inmediato del sangrado activo. En otro paciente se colocó un catéter doble J por disrupción de la vía excretora. De los pacientes tratados de manera conservadora inicialmente solo 1 paciente (4,1%) requirió maniobras quirúrgicas secundarias debido a una complicación. CONCLUSIONES: En pacientes con traumatismo renal el tratamiento no quirúrgico es seguro y eficaz. En caso de inestabilidad hemodinámica o complicación, las técnicas radiológicas intervencionistas han demostrado ser seguras y efectivas en la edad pediátrica.

Experiencia en el tratamiento conservador del traumatismo renal / Experience in the conservative treatment of renal trauma

Objetivo: El manejo del traumatismo renal ha ido variando en los últimos años de modo que en la actualidad, incluso en los grados altos, se aboga por un tratamiento inicial conservador. El objetivo de este trabajo es revisar la presentación, actitud inicial y evolución de los traumatismos renales atendidos en nuestra institución. Material y métodos: Revisión retrospectiva de pacientes con traumatismo renal atendidos en los últimos 10 años. Se analizaron las variables epidemiológicas, mecanismo de producción, índice de trauma pediátrico (ITP), tratamiento y evolución. Resultados: Se estudiaron 26 pacientes, 18 varones (69,23%). La causa más frecuente fue el golpe directo en 11 pacientes (42,31%). El lado más frecuentemente afectado fue el derecho en 14 pacientes (53,85%). El traumatismo grado III según la American Association for the Surgery of Trauma (AAST) fue el más común, 11 pacientes (42,31%). Nueve pacientes (44,55%) presentaron lesiones concomitantes en otros órganos sólidos. En 24 pacientes (92,30%) el tratamiento inicial fue conservador con medidas de soporte. Un paciente se presentó con inestabilidad hemodinámica y se intervino de forma urgente realizándose embolización supraselectiva con control inmediato del sangrado activo. En otro paciente se colocó un catéter doble J por disrupción de la vía excretora. De los pacientes tratados de manera conservadora inicialmente solo 1 paciente (4,1%) requirió maniobras quirúrgicas secundarias debido a una complicación. Conclusiones: En pacientes con traumatismo renal el tratamiento no quirúrgico es seguro y eficaz. En caso de inestabilidad hemodinámica o complicación, las técnicas radiológicas intervencionistas han demostrado ser seguras y efectivas en la edad pediátrica

Objective: The management of renal trauma has been changing in recent years so that nowadays, even in high grades, an initial conservative treatment is advocated. The aim of this work is to review the presentation, initial attitude and evolution of the renal traumas treated in our institution. Material and methods: Retrospective review of patients with renal trauma treated at our institution in the last 10 years. Epidemiological variables, production mechanism, pediatric trauma index (PTI), treatment and evolution were analyzed. Results: We studied 26 patients, 18 men (69.3%). The most frequent mechanism was the direct hit in 11 patients (42.31%). The most frequently side affected was the right one in 14 patients (53.85%). The grade III traumatism according to American Association for the surgery of Trauma (AAST) was the most repeated, 11 patients (42.31%). Nine patients (44.55%) presented concomitant injuries in other solid organs. In 24 patients (92.30%) the initial treatment was conservative with supportive measures. One patient presented with hemodynamic instability and an urgent intervention was conducted, performing a supraselective embolization with immediate control of the active bleeding. In another patient, a double J catheter was placed due to disruption of the excretory tract. Of the patients treated conservatively initially, only one patient (4.1%) required secondary surgical maneuvers due to a complication. Conclusions: In patients with renal trauma, non-surgical treatment is safe and effective. In case of hemodynamic instability or complication, interventional radiological techniques have been demonstrated to be safe and effective in the pediatric population

Análisis del perfil de seguridad del tratamiento con un número ampliado de ondas de choque por sesión en litotricia extracorpórea / Analysis of the safety profile of treatment with a large number of shock waves per session in extracorporeal lithotripsy

Objetivo: Evaluar la seguridad del incremento del número de ondas por sesión en el tratamiento de la litiasis urinaria mediante litotricia extracorpórea. Material y métodos: Estudio prospectivo, comparativo, no aleatorizado, de grupos paralelos de pacientes con litiasis reno-ureteral e indicación de litotricia extracorpórea incluidos consecutivamente entre 2009 y 2010. Se comparó un grupo i (160 pacientes) tratado programadamente con un número medio de ondas/sesión estándar (2858,3 ± 302,8) y un litotriptor Dornier Lithotripter U/15/50, frente a un grupo ii (172 pacientes) tratado con un número medio de ondas/sesión ampliado (6728,9 ±889,6) y un litotriptor Siemens Modularis. Las variables analizadas fueron edad, sexo, localización, tamaño de la litiasis, número de ondas/sesión y totales hasta la resolución, tasa libre de litiasis (TLL) y tasa de complicaciones (clasificación Clavien-Dindo). Para el análisis estadístico fueron empleados la «t» de Student y la Chi cuadrado. Resultados: La tasa de complicaciones totales fue 11,9% para el grupo i y 10,46% para el grupo ii (p = 0,39). Todas ellas fueron complicaciones menores grado i (Clavien-Dindo). La más frecuente en el grupo i fue el dolor cólico y en el grupo ii la hematuria, con tasa de intolerancia al tratamiento similar (p > 0,05). El número de ondas totales necesarias fue inferior en el grupo ii respecto al grupo i (p = 0,001), con TLL del 96,5% y 71,5% respectivamente (p = 0,001). Conclusión: El tratamiento con un número ampliado de ondas por sesión en litotricia extracorpórea no implica mayor tasa de complicaciones ni mayor severidad de las mismas. Sin embargo, podría aumentar la efectividad global del tratamiento

Objective: To assess the safety of increasing the number of waves per session in the treatment of urolithiasis using extracorporeal lithotripsy. Material and methods: Prospective, comparative, nonrandomized parallel study of patients with renoureteral lithiasis and an indication for extracorporeal lithotripsy who were consecutively enrolled between 2009 and 2010. We compared group I (160 patients) treated on schedule with a standard number of waves/session (mean 2858,3 ± 302,8) using a Dornier lithotripter U/15/50 against group II (172 patients) treated with an expanded number of waves/session (mean, 6728,9 ± 889,6) using a Siemens Modularis lithotripter. The study variables were age, sex, location, stone size, number of waves/session and total number of waves to resolution, stone-free rate (SFR) and rate of complications (Clavien-Dindo classification). Student's t-test and the chi-squared test were employed for the statistical analysis. Results: The total rate of complications was 11.9% and 10.46% for groups I and II, respectively (P = .39). All complications were minor (Clavien-Dindo grade I). The most common complications were colic pain and hematuria in groups I and II, respectively, with a similar treatment intolerance rate (P > .05). The total number of waves necessary was lower in group II than in group I (P = .001), with SFRs of 96.5% and 71.5%, respectively (P = .001). Conclusion: Treatment with an expanded number of waves per session in extracorporeal lithotripsy does not increase the rate of complications or their severity. However, it could increase the overall effectiveness of the treatment

Analysis of the safety profile of treatment with a large number of shock waves per session in extracorporeal lithotripsy.

OBJECTIVE: To assess the safety of increasing the number of waves per session in the treatment of urolithiasis using extracorporeal lithotripsy. MATERIAL AND METHODS: Prospective, comparative, nonrandomized parallel study of patients with renoureteral lithiasis and an indication for extracorporeal lithotripsy who were consecutively enrolled between 2009 and 2010. We compared group I (160 patients) treated on schedule with a standard number of waves/session (mean 2858,3±302,8) using a Dornier lithotripter U/15/50 against group II (172 patients) treated with an expanded number of waves/session (mean, 6728,9±889,6) using a Siemens Modularis lithotripter. The study variables were age, sex, location, stone size, number of waves/session and total number of waves to resolution, stone-free rate (SFR) and rate of complications (Clavien-Dindo classification). Student's t-test and the chi-squared test were employed for the statistical analysis. RESULTS: The total rate of complications was 11.9% and 10.46% for groups I and II, respectively (P=.39). All complications were minor (Clavien-Dindo grade I). The most common complications were colic pain and hematuria in groups I and II, respectively, with a similar treatment intolerance rate (P>.05). The total number of waves necessary was lower in group II than in group I (P=.001), with SFRs of 96.5% and 71.5%, respectively (P=.001). CONCLUSION: Treatment with an expanded number of waves per session in extracorporeal lithotripsy does not increase the rate of complications or their severity. However, it could increase the overall effectiveness of the treatment.

La Sección de Urología Pediátrica del Hospital Universitario y Politécnico La Fe / The Pediatric Urology Section of the University and Polytechnic Hospital La Fe

Objetivo. El objetivo de este trabajo es analizar la actividad asistencial, docente y científica realizada por la sección de Urología Pediátrica del Hospital Universitario y Politécnico La Fe en los últimos años. Material and métodos. Realizamos un estudio retrospectivo analizando las visitas a consultas externas, pacientes hospitalizados, estudios urodinámicos y el número y tipo de intervenciones quirúrgicas realizadas. Revisamos retrospectivamente la actividad docente y científica. Resultados. La media de pacientes atendidos en consultas externas es de 3.821 al año, se han realizado 262 pruebas funcionales en 2013, el número de pacientes hospitalizados y el número de intervenciones quirúrgicas han aumentado un 36 y 22 % respectivamente. La actividad docente y científica supone una importante dedicación en la práctica diaria. Conclusiones. La sección de Urología Pediátrica del Hospital Universitario y Politécnico La Fe es centro de referencia de las distintas enfermedades urológicas del niño, atiende todas las patologías urológicas que a este afectan y realiza los distintos tipos técnicas e intervenciones que precisan. La actividad asistencial que realiza se ha incrementado en los últimos años, con una importante dedicación a la actividad docente y científica (AU)

Objetive. The aim of this paper is to analyze assistance, educational and scientific activity carried out by the Pediatric Urology unit of the Hospital Universitario y Politécnico La Fe in last years. Methods. We retrospectively analyzed out patient visits, hospitalization, urodynamic studies and the number and type of surgical procedures performed. We retrospectively reviewed the educational and scientific activity. Results. The average number of patients seen in out patients clinics is 3821 per year, 262 functional tests were performed in 2013, hospitalization and surgical procedures have increased (36% and 22% respectively). Educational and scientific activity is a important dedication in daily practice. Conclusion. Pediatric Urology unit of Hospital Universitario y Politécnico La Fe is a reference center for child urological diseases, attends all child urological diseases and performs different techniques and surgical procedures. Assistential activity has increased in recent years, with a significant dedication to educational and scientific one (AU)