Can double J stent complications be reduced in pediatric patients? / ¿Podemos reducir las complicaciones de doble J en el paciente pediátrico?

OBJECTIVE: The use of double J (DJ) stents is frequent in urological pediatrics, but it is not exempt from morbidity. The objective of this study was to describe the risk factors (RF) of DJ complications in pediatric patients, and to analyze the quality of the information provided to the families with respect to the stent. MATERIALS AND METHODS: A retrospective study of patients undergoing surgery with DJ placement in the urology department from 2017 to 2022 was carried out. Study patients were divided into two groups -complicated (C) and non-complicated (NC). A multivariate analysis was performed to identify complication-related RFs, and a quality analysis as perceived by the families was conducted by means of a satisfaction survey (0 = total dissatisfaction; 10 = maximum satisfaction). RESULTS: 180 patients were included (236 DJs). The main diagnoses included renal transplantation (29.8%), ureteropelvic stenosis (26%), and urolithiasis (20.7%). Complication rate was 21.9%, with a mean comprehensive complication index (CCI) of 26.8. Prophylactic antibiotic therapy was not associated with fewer complications (97.3% vs. 98.1%; p= 0.727). Complication RFs included more than one stent (p< 0.001; OR= 6.628) and bilateral placement (p< 0.05; OR= 4.871). Poor registration in the medical records was associated with greater complications (p= 0.025). In the information quality survey, 20% reported a score lower than 7/10. CONCLUSIONS: DJ-associated morbidity has a direct relationship with DJ duration, bilaterality, and carrying more than one stent in a lifetime. Adequate registration in the medical records is associated with shorter DJ duration, and therefore, fewer complications. Antibiotic prophylaxis did not reduce complications, which means its routine use should be reconsidered.

OBJETIVOS: El uso de catéteres doble J (DJ) es un proceso frecuente en uropediatría, pero no exento de morbilidad. El objetivo de nuestro estudio es describir factores de riesgo (FR) de complicación de los DJ en pacientes pediátricos y comprobar la calidad de la información transmitida a las familias en relación al catéter. MATERIAL Y METODOS: Estudio retrospectivo de pacientes intervenidos en urología con colocación de DJ (2017­2022). Grupos a estudio: complicados (CC) y no complicados (SC). Realizamos un análisis multivariante para identificar FR relacionados con complicaciones y un análisis de calidad percibida por las familias mediante encuesta de satisfacción (0 no satisfacción, 10 máxima satisfacción). RESULTADOS: Incluimos 180 pacientes, (236 DJ). Diagnósticos principales: trasplante renal 29,8%, estenosis pieloureteral 26%, y urolitiasis 20,7%. La tasa de complicaciones fue del 21,9%, con un Comprehensive Complication Index (CCI) medio de 26,8. La antibioterapia profiláctica no se relaciona con menos complicaciones (97,3% vs 98,1% p= 0,727). FR de complicación: acumular más de un catéter (p< 0,001, OR 6,628) o la colocación bilateral (p< 0,05; OR 4,871). Un mal registro en la historia clínica se relacionó con más complicaciones (p= 0,025). En la encuesta de calidad de información recibida, el 20% reflejaron una puntuación inferior a 7/10. CONCLUSIONES: La morbilidad asociada al DJ se relaciona con su duración, la bilateralidad o acumular más de un catéter. Su adecuado registro en la historia clínica se relaciona con menor duración del mismo y, por tanto, menos complicaciones. La profilaxis antibiótica no ha demostrado disminuir las complicaciones, su uso rutinario debe ser revalorado.

¿Podemos reducir las complicaciones de doble J en el paciente pediátrico? / Can double J stent complications be reduced in pediatric patients?

Objetivos: El uso de catéteres doble J (DJ) es un proceso frecuenteen uropediatría, pero no exento de morbilidad. El objetivo de nuestroestudio es describir factores de riesgo (FR) de complicación de losDJ en pacientes pediátricos y comprobar la calidad de la informacióntransmitida a las familias en relación al catéter. Material y métodos: Estudio retrospectivo de pacientes intervenidos en urología con colocación de DJ (2017–2022). Grupos a estudio: complicados (CC) y no complicados (SC). Realizamos un análisismultivariante para identificar FR relacionados con complicaciones yun análisis de calidad percibida por las familias mediante encuesta desatisfacción (0 no satisfacción, 10 máxima satisfacción).Resultados. Incluimos 180 pacientes, (236 DJ). Diagnósticos principales: trasplante renal 29,8%, estenosis pieloureteral 26%, y urolitiasis20,7%. La tasa de complicaciones fue del 21,9%, con un ComprehensiveComplication Index (CCI) medio de 26,8. La antibioterapia profilácticano se relaciona con menos complicaciones (97,3% vs 98,1% p= 0,727). FR de complicación: acumular más de un catéter (p< 0,001, OR 6,628)o la colocación bilateral (p< 0,05; OR 4,871). Un mal registro en lahistoria clínica se relacionó con más complicaciones (p= 0,025). Enla encuesta de calidad de información recibida, el 20% reflejaron unapuntuación inferior a 7/10. Conclusiones: La morbilidad asociada al DJ se relaciona con suduración, la bilateralidad o acumular más de un catéter. Su adecuadoregistro en la historia clínica se relaciona con menor duración del mismo y, por tanto, menos complicaciones. La profilaxis antibiótica no hademostrado disminuir las complicaciones, su uso rutinario debe serrevalorado.(AU)

Objective: The use of double J (DJ) stents is frequent in urologicalpediatrics, but it is not exempt from morbidity. The objective of this studywas to describe the risk factors (RF) of DJ complications in pediatricpatients, and to analyze the quality of the information provided to thefamilies with respect to the stent.Materials and methods: A retrospective study of patients undergoing surgery with DJ placement in the urology department from 2017to 2022 was carried out. Study patients were divided into two groups –complicated (C) and non-complicated (NC). A multivariate analysis wasperformed to identify complication-related RFs, and a quality analysisas perceived by the families was conducted by means of a satisfactionsurvey (0 = total dissatisfaction; 10 = maximum satisfaction). Results: 180 patients were included (236 DJs). The main diagnosesincluded renal transplantation (29.8%), ureteropelvic stenosis (26%), andurolithiasis (20.7%). Complication rate was 21.9%, with a mean comprehensive complication index (CCI) of 26.8. Prophylactic antibiotic therapywas not associated with fewer complications (97.3% vs. 98.1%; p=0.727). Complication RFs included more than one stent (p<0.001; OR=6.628)and bilateral placement (p<0.05; OR=4.871). Poor registration in themedical records was associated with greater complications (p=0.025). Inthe information quality survey, 20% reported a score lower than 7/10.Conclusions: DJ-associated morbidity has a direct relationshipwith DJ duration, bilaterality, and carrying more than one stent in alifetime. Adequate registration in the medical records is associatedwith shorter DJ duration, and therefore, fewer complications. Antibiotic prophylaxis did not reduce complications, which means its routineuse should be reconsidered.(AU)

Papel de la laparoscopia en prematuros con sospecha de enterocolitis necrotizante / Role of laparoscopy in premature infants with suspicion of necrotizing enterocolitis

Introducción. La indicación quirúrgica en la enterocolitis necrotizante(ECN) puede ser difícil en ausencia de neumoperitoneo o peritonitis secundaria. Proponemos la laparoscopia para realizar un diagnóstico precoz de perforaciones o necrosis intestinal y evitar laparotomías “en blanco”. Material y métodos. Se planteó un protocolo diagnóstico terapéutico que incluyera la laparoscopia en los casos de ECN de indicación quirúrgica incierta. Posteriormente se realizó un estudio prospectivo de los 7 pacientes en los que se realizó laparoscopia, analizando efectos fisiopatológicos en el prematuro, dificultades técnicas del procedimiento, congruencia diagnóstica y evolución postoperatoria. Resultados. La edad gestacional media al nacimiento fue de 27semanas (rango 25 a 31) con un peso medio de 1,147 kg (rango 0,900 a1,600). Se colocaron dos trócares orientados según la focalidad de la exploración o la radiología, aplicando un neumoperitoneo de 6-10 mm Hg durante una media de 17 min. La laparoscopia evitó la laparotomía en un paciente, que evolucionó bien tras lavado y drenaje; y magnificólas lesiones en otro paciente que, tras la laparotomía, no precisó derivación intestinal. En el resto de los casos la laparoscopia permitió una minilaparotomía orientada a las lesiones y derivación intestinal. No se produjo ninguna complicación quirúrgica atribuible al procedimiento, que fue bien tolerado en todos los casos. Conclusiones. La laparoscopia puede ser una herramienta útil para valoración de las lesiones de ECN en los casos de indicación quirúrgica incierta. En nuestra experiencia es bien tolerada en el neonato de bajo peso, permitiendo orientar el tratamiento quirúrgico e, incluso, evitarla laparotomía (AU)

Introduction. The indication of surgery in necrotizing enterocolitis(NEC) can be difficult in the absence of pneumoperitoneum or peritonitis. We propose laparoscopy for early diagnosis of intestinal perforation or necrosis in order to avoid unneccessary laparotomies. Material and methods. A new protocol was proposed which included diagnostic and therapeutic laparoscopy in cases of uncertain surgical ECN indication. Subsequently, a prospective study of the 7 patients who underwent laparoscopy was performed, analyzing pathophysiological effects in the premature, technical difficulties of the procedure, and postoperative diagnostic consistency. Results. The mean gestational age at birth was 27 weeks (range 25 to31) with an average weight of 1.147 kg (range 0.900 to 1.600) two trocars were placed as the focal oriented scanning or radiography, using a pneumoperitoneum6-10 mmHg for an average of 17 min. Laparoscopy avoided laparotomy in a patient who did well after washing and drainage and magnified lesions in one patient who did not require laparotomy after intestinal bypass. In other cases, laparoscopy was followed by minilaparotomy oriented to the lesions and stoma formation. There were no surgical complications attributable to the procedure, which was well tolerated in all cases. Conclusions. Laparoscopy can be a useful tool for evaluation of lesions of NEC in cases of uncertain surgical indications. In our experience ,it is well tolerated in neonates of low weight, allowing oriented minilaparotomies or even to avoid laparotomy (AU)

[Role of laparoscopy in premature infants with suspicion of necrotizing enterocolitis]. / Papel de la laparoscopia en prematuros con sospecha de enterocolitis necrotizante.

INTRODUCTION: The indication of surgery in necrotizing enterocolitis (NEC) can be difficult in the absence of pneumoperitoneum or peritonitis. We propose laparoscopy for early diagnosis of intestinal perforation or necrosis in order to avoid unneccessary laparotomies. MATERIAL AND METHODS: A new protocol was proposed which included diagnostic and therapeutic laparoscopy in cases of uncertain surgical ECN indication. Subsequently, a prospective study of the 7 patients who underwent laparoscopy was performed, analyzing pathophysiological effects in the premature, technical difficulties of the procedure, and postoperative diagnostic consistency. RESULTS: The mean gestational age at birth was 27 weeks (range 25 to 31) with an average weight of 1.147 kg (range 0.900 to 1.600) two trocars were placed as the focal oriented scanning or radiography, using a pneumoperitoneum 6-10 mmHg for an average of 17 min. Laparoscopy avoided laparotomy in a patient who did well after washing and drainage and magnified lesions in one patient who did not require laparotomy after intestinal bypass. In other cases, laparoscopy was followed by minilaparotomy oriented to the lesions and stoma formation. There were no surgical complications attributable to the procedure, which was well tolerated in all cases. CONCLUSIONS: Laparoscopy can be a useful tool for evaluation of lesions of NEC in cases of uncertain surgical indications. In our experience, it is well tolerated in neonates of low weight, allowing oriented minilaparotomies or even to avoid laparotomy.

Estrategia terapéutica en la extrofia de cloaca femenina / Therapeutic strategy in cloacal exstrophy

La extrofia de cloaca femenina enfrenta al cirujano pediá- trico con un reto en el que está implicada la reconstrucción del tracto genitourinario y digestivo así como su manejo funcional. El objetivo de nuestro trabajo es presentar nuestra experiencia en el manejo de las malformaciones genitales en niñas con extrofia de cloaca así como de la continencia urinaria y fecal. Revisamos las historias clínicas de las pacientes tratadas en nuestro centro en las que se ha llegado a una corrección definitiva del espectro malformativo de la extrofia de cloaca. En las tres pacientes se ha realizado un cierre del cuello vesical y un estoma cateterizable continente a través del cual llevan a cabo un programa de autocateterismo vesical intermitente, manteniéndose secas. Con respecto a la integración psicosexual, las tres pacientes están satisfechas con el resultado cosmético obtenido, aunque sólo una de ellas mantiene relaciones sexuales. El manejo de la extrofia de cloaca femenina debe tener en cuenta tanto los factores anatómicos como funcionales. La reconstrucción genital en niñas con extrofia de cloaca requiere un plan ajustado en cada paciente y en ocasiones realizar varias intervenciones hasta que la paciente esté satisfecha con el resultado tanto cosmético como funciona (AU)

Cloacal exstrophy is a complex multisistemic anomaly thatinvolves gastrointestinal and genitourinary issues. The aim of our paper is to report our experience in dealing with genital reconstruction and faecal and urinary continence in patients with female cloacal anomalies. We reviewed the clinical records from the three patients we have achieved a final reconstruction. We recorded the surgical management and both functional and anatomic results. The three of them required a bladder neck closure associated with a continent stoma, they are dry with intermittent catheterization and free of upper urinary complications. Genital reconstruction required a unique plan for each one, according to their anatomy and their cosmetic desires. One of the patients reported satisfactory sexual intercourse. Management of patients with cloacal exstrophy has major concerns about urinary and fecal continence and about genital reconstruction and function. Knowing the long-term results may help to develop management strategies and improve counselling for patients who have undergone reconstruction (AU)

[The paraurethral cyst or Skene's duct cyst in the female newborn]. / Quiste parauretral de Skene en niña recién nacida.

The paraurethral cyst or Skene's duct cyst is a rare congenital anomaly in the female newborn. It appears like a round, yellow or orange-colored cystic mass on either side of the urethral meatus. The reported incidence is 1 in 2.000 to 7.000 female births. The low frequency of the Skene's duct cyst and the little awareness of it and its benignity may lead to wrong diagnosis that underestimates its incidence. There are authors that agree with surgical treatment of paraurethral cyst to obtain an early resolution, even though a majority agrees to manage conservatively.

Quiste parauretral de Skene en niña recién nacida / The paraurethral cyst or Skene´s duct cyst in the female newborn

El quiste parauretral o quiste del conducto de Skene es una rara anomalía congénita descrita en neonatos de sexo femenino. Se trata de una formación quística que se muestra como una tumoración redonda, amarillenta o anaranjada, que se presenta adyacente al meato externo uretral. Su incidencia en la población se cifra entre 1 de cada 2.000 y 1 de cada 7.000 recién nacidos vivos femeninos. Sin embargo, sólo se recogen 47 ejemplos anteriores en la literatura en inglés. Es posible que el desconocimiento de esta patología entre la población médica y su benignidad produzcan fallos diagnósticos que infravaloren esta incidencia. Aunque existen autores que apoyan el tratamiento quirúrgico del quiste para lograr su curación, más aún a partir de los 6 meses de edad, la mayoría se ponen de acuerdo en la indicación de un tratamiento expectante dada la tendencia a la resolución espontánea

The paraurethral cyst or Skene´s duct cyst is a rare congenital anomaly in the female newborn. It appears like a round, yellow or orange-colored cystic mass on either side of the urethral meatus. The reported incidence is 1 in 2.000 to 7.000 female births. The low frequency of the Skene´s duct cyst and the little awareness of it and its benignity may lead to wrong diagnosis that underestimates its incidence. There are authors that agree with surgical treatment of paraurethral cyst to obtain an early resolution, even though a majority agrees to manage conservatively

[Therapeutic strategy in cloacal exstrophy]. / Estrategia terapéutica en la extrofia de cloaca femenina.

Cloacal exstrophy is a complex multisistemic anomaly that involves gastrointestinal and genitourinary issues. The aim of our paper is to report our experience in dealing with genital reconstruction and faecal and urinary continence in patients with female cloacal anomalies. We reviewed the clinical records from the three patients we have achieved a final reconstruction. We recorded the surgical management and both functional and anatomic results. The three of them required a bladder neck closure associated with a continent stoma, they are dry with intermittent catheterization and free of upper urinary complications. Genital reconstruction required a unique plan for each one, according to their anatomy and their cosmetic desires. One of the patients reported satisfactory sexual intercourse. Management of patients with cloacal exstrophy has major concerns about urinary and fecal continence and about genital reconstruction and function. Knowing the long-term results may help to develop management strategies and improve counselling for patients who have under-gone reconstruction.

Atresia de esófago / Esophageal atresia

La atresia esofágica, generalmente acompañada de fistula traqueoesofágica, es la malformación congénita más frecuente del esófago. Descrita por primera vez por William Durston en 1670, la primera reparación exitosa no se consiguió hasta 1941, llevada a cabo por Haigth y Towsley. El manejo de los pacientes con atresia de esófago ha sufrido importantes mejorías, aunque todavía constituye un reto tanto el tratamiento quirúrgico como el tratamiento de las complicaciones y las secuelas de aparición tardía (AU)

First Spanish Trauma Registry: analysis of 1500 cases.

OBJECTIVES: To develop the first Spanish Pediatric Trauma Registry to collect and evaluate infomation concerning aspects of injuries in our pediatric population. METHODS: From January 1995 to August 1998, 35,946 children younger than 16 years were treated in our hospital for acute injury: 1500 were admitted and included in our database. Our file registry consists of 108 data points including: patient identification, type, place and mechanism of injury, pre-hospital care, transport, assessment on admission, severity scores, diagnostic studies, injuries, treatment morbidity and mortality. RESULTS: Accidents were more frequent in males (68%) than in females. The predominant age group was 12-15 years of age (34%). Accidents were more frequent in the street (35.1%) than at home (18.9%) or school (13%). Falls and traffic-related accidents were the leading cause of injury (39% and 21.2%, respectively). Two hundred and thirty-five (15.7%) had a Pediatric Trauma Score < or = 8. Fifty of these sustained multiple trauma (33%) (Injury Severity Score > or = 15). Musculoskeletal and head trauma were the most frequent injuries (48.5% and 42.0%, respectively). Surgical or orthopedic procedures were performed in 906 patients (56.5%). The average length of stay was 4.5 days (range 1-93 days). Functional impairment in children older than 4 years of age was found in 413 children (33.3%). We encountered 7 deaths in the 1500 patients, or an overall mortality of 0.5%. These 7 deaths were only seen in the I.S.S. > or = 15 group (50 patients) with 14% mortality. CONCLUSIONS: The goals of this Registry are to establish the epidemiology of our injured pediatric population, to review patient care, to develop prevention programs and to compare results with other centers so that potential deficiencies can be corrected.