Papel de los alfa-antagonistas en el síndrome de micción no coordinada en la infancia / Role of alpha antagonists in uncoordinated micturition syndrome in childhood

Introducción. El síndrome de micción no coordinada se caracteriza por un cuadro de disfunción de vaciado vesical debido a la contracción activa del esfínter externo durante el vaciado. Su diagnóstico se basa en los resultados flujoméricos y electromiográficos y el tratamiento está enfocado a mejorar la relajación del esfínter durante la micción, siendo el biofeedback el tratamiento de elección. Dado que aún existen centros sin esta posibilidad, la alternativa son los alfa-bloqueantes, sin mucha literatura al respecto. Objetivo. Determinar la eficacia de los alfa-bloqueantes como tratamiento alternativo al biofeedback en ausencia de este como posibilidad terapéutica. Material y métodos. Presentamos un total de 17 casos de síndrome de Hinman que se encuentran en seguimiento en la consulta de urología pediátrica. Realizamos un estudio retrospectivo. Valoramos la edad y sintomatología al diagnóstico, la presencia de patología urológica asociada, los resultados flujométricos pre y posttratamiento, el tipo (..) (AU)

Introduction. Dysfunctional voiding syndrome in children is characterized by a pattern of dysfunctional bladder emptying due to an active contraction of the external sphincter during micturition. Diagnosis is based on electromyographic and flow metry results. The treatment is focused on relaxing the external sphincter during micturition where biofeedback is the treatment of choice. By the moment there are still centres without this possibility, alpha blockers are an alternative. Objective: To determine the efficacy of alpha blockers as an alternative to biofeedback as a therapeutic possibility. Material and methods: We included a total of 17 children with dysfunctional voiding syndrome and carried out a retrospective study. We registered age, symptoms at diagnosis, presence of associated urologic problems, flow metry results pre and post-treatment, type of treatment used and its effectiveness comparing patients treated with alpha blockers and those who are starting to deal with biofeedback. Results. There were 12 girls and 5 boys. The mean age at diagnosis (..) (AU)

[Quality of life in children operated on for anal atresia]. / Calidad de vida en los pacientes intervenidos de atresia de ano.

INTRODUCTION: Most children with anorectal malformations have some type of intestinal dysfunction. A correct follow up in this aspect after surgery affects their quality of life. MATERIAL AND METHODS: We gathered a sample of 20 children that were lost in their follow up after posterior sagittal anorectoplasty (PSARP). We got contact with them and they were interviewed and examined in our department. RESULTS: We collected 12 girls and 8 boys. Age range was between 3 and 14 years. 70% had good prognosis for continence (low fistula) and 30% poor prognosis (high fistula). 35% suffered from postoperative complications being the most frequent prolapse especially in high atresias. 85% had good rectal sensitivity, 15% had poor sensitivity that was directly related to incontinence. Anal tone was decreased in our exploration in 35% of patients which was not directly related to their continence. 65% suffered constipation with or without fecaloma. 5% of cases had intestinal hipermotility. The total incidence of fecal loose was 40%. More than a half (62,5%) kept on loosing stool despite treating their constipation or hipermotility, so we consider them true incontinents (no voluntary bowel movements). 67% of children with high fistula were true incontinents, just 7% of those with low fistula. Subjective quality of life in patients with soling was 6.4. In clean patients it was 9.3. Objective quality of life (Score/13) in dirty patients was 6.6. In Clean patients: 11.9. After our bowel management protocol we got 100% of patients clean during school time, thereby improving their quality of life. CONCLUSIONS: Incontinence determines the long-term quality of life in our patients in addition to the psycho-social consequences. They are clearly more frequent in patients with high fistula. Much assume incontinence as an unavoidable part of their disease so do not always demand treatment if they are not followed by a surgeon.

Calidad de vida en los pacientes intervenidos de atresia de ano / Quality of life in children operated on for anal atresia

Introducción. El utrículo prostático consiste en una regresión incompleta de las estructuras Müllerianas. Puede presentar varios signos y síntomas, como incontinencia e infecciones del tracto urinario. Presentamos nuestra experiencia personal en la extirpación laparoscópica de lutrículo prostático en pacientes con sintomatología de ITU e incontinencia. Material y Métodos. La cirugía consiste en una cistouretroscopia y canalización del utrículo con colocación de sonda de Fogarty nº4 o del cistoscopio en el interior, si este atraviesa el orificio. Esta maniobra ayuda a la localización. La laparoscopia se lleva a cabo con un trocar de 10 mm y dos de 5 mm. Gracias a la tras iluminación, la localización es más sencilla. La resección se realiza con electrocoagulación y extirpación tras puntos transfixivos. Resultados. Se operaron cinco varones con una media de edad de7 (2-11) años. En todos la laparoscopia fue satisfactoria excepto en uno, que necesitó la reconversión a cirugía abierta. La media de duración fue de 110 (90-210) min. Conclusión. La exéresis laparoscópica del utrículo prostático es una vía segura y sencilla de tratamiento. La iluminación directa con el cistoscopio ayuda a la visualización y disección del mismo (AU)

Introduction. The prostatic utricle is an embryological remnantfrom Müllerian duct tissue. Most prostatic utricles are asympomatic, but they may manifest as a urinary tract infection or an incontinence. Material and method. Surgery consists in a cysto-urethroscopy and cannulation of the prostatic utricle with a ureteral catheter (Fogarty ner 4) and the cystoscopy left in situ to facilitate identification and mobilization. A 10 mm port through a umbilical incision and two more5 mm working ports were inserted. After mobilization, the ureteral defect was closed by an absorbable suture and ultrasonic coagulation. Results. Five boys with symptomatic prostatic utricles underwent surgery at a mean (range) age of 7 (2-11) years. The laparoscopic escisión was successful in all but one due to a bleeding. The mean (range) operative duration was 165 (120-240) min. Conclusion. Laparoscopic escision under cystoscopic guidance offers a good surgical view and allowing easy dissection (AU)

[Role of alpha antagonists in uncoordinated micturition syndrome in childhood]. / Papel de los alfa-antagonistas en el síndrome de micción no coordinada en la infancia.

INTRODUCTION: Dysfunctional voiding syndrome in children is characterized by a pattern of dysfunctional bladder emptying due to an active contraction of the external sphincter during micturition. Diagnosis is based on electromyographic and flowmetry results. The treatment is focused on relaxing the external sphincter during micturition where biofeedback is the treatment of choice. By the moment there are still centres without this possibility, alpha blockers are an alternative. OBJECTIVE: To determine the efficacy of alpha blockers as an alternative to biofeedback as a therapeutic possibility. MATERIAL AND METHODS: We included a total of 17 children with dysfunctional voiding syndrome and carried out a retrospective study. We registered age, symptoms at diagnosis, presence of associated urologic problems, flowmetry results pre and post-treatment, type of treatment used and its effectiveness comparing patients treated with alpha blockers and those who are starting to deal with biofeedback. RESULTS: There were 12 girls and 5 boys. The mean age at diagnosis was 4.9 years old, 88% of these children related enuresis, diurnal urinary incontinence and urgency, 57% of them had also urinary infections, 63% constipation, 36% had psychosocial problems. Ten patients were treated with alpha-antagonists: 6 with Tamsulosin and 4 with Doxazosin. They followed this treatment an average of 5.8 months, range between 2 and 12 months. Five patients were treated with biofeedback. All cases had an abnormal pelvic electromyography. Patients treated with alpha-blockers achieved a 70% of electromyographic improvement with a 70% of recurrence. In children treated with biofeedback we got improvement in 80% with no recurrence. After alpha blocker therapy, maximum flow rates and average flow values were better but not statistically significant, this difference was significant with biofeedback. A patient treated with Tamsulosin left treatment due to hypotension, 2 patients left Doxazosin because of dizziness. CONCLUSIONS: Alpha-blockers are effective in the treatment of dysfunctional voiding syndrome with a high percentage of recurrence. They can be an alternative to biofeedback but this one is the effective and definitive treatment.

[Correction of lop ear using minimally invasive approach]. / Corrección de las orejas procidentes mediante un abordaje mínimamente invasivo.

INTRODUCTION: Helix valgus or procident ears is a common problem that affects about 5% of the population. The folds of the antehelix and the overdevelopment of the concha are the most commonly found anatomic alterations of the ear pavilion. In children this pathology usually causes anxiety and an emotional trauma that may interfere in their normal development. MATERIALS AND METHODS: There are a few tipes of techniques to correct helix valgus. We present the application of the technique in our service. We conduct the otoplastia with an outer puntiform technique which allows us to cut the cartilage partially from the outside. Next we fold from the rear the antehelix and hide the concha. RESULTS: We analysed 7 years of the application of this technique and we now present 87 otoplastias conducted to 44 children. The 97% of them were bilateral. No precocious complications have been observed after the surgery. All cases except for one of them have been bilateral. All the patients were satisfied with the aesthetic results. None of them showed relapse. In one case there was a hypertrophic scar that required cutting and in 2 of the cases there was a slight hypercorrection. CONCLUSIONS: Procident ears may occasion a psychological trauma in children. We believe that this technique, which is minimally invasive, provides very satisfactory aesthetic results, the puntiform scar being hardly noticed fifteen days before surgery. The patients need to stay in hospital for a short period, 24-48 hours, and complications are very rare, recidiva has not been described. We strongly recommend this technique for the correction of procident ears.

[Non-palpable testes: laparoscopic or inguinal approach?]. / Testes no palpables: abordaje laparoscópico o inguinal?

INTRODUCTION: Twenty per cent of the operated patients suffering from cryptorchidisim show no palpable testis in the physical check-up. The use of a non-palpable testis in the initial stages is considered to be controversial when deciding between a laparascopic or an inguinal approach. Our aim is to compare the results obtained with these two approaches and evaluate which one of them would be the most relevant as an initial option. MATERIALS AND METHODS: We examined the patients who have been subjected to surgical intervention for non-palpable testis in the last three years. We had a sample of 53 patients. Bilateral non-palpable testes were disregarded. In the case of 35 patients the initial approach was through the groins while in 18 of them the approach was laparascopic. Relevant data were recorded, such as the age of the patient, right or left side, surgical findings, need for a laparascopic or groin approach and associated hernia. RESULTS: The average age of the patients at the time of the surgical treatment was 3.7 years R (1-13 years). 42% of the testes were on the right side and 58% on the left. In an initial stage the inguinal approach was used with 35 patients, 2 of these requiring laparascopic exploration due to a non-concluding check-up; it was concluded that they were 2 cases of anorchia. An initial laparoscopic approach was used with 18 patients. Internal vessels in the canal were found which required an inguinal approach. In 12 patients normal or atrophic testes were observed. Testicular descent was achieved through the groin in 10 of them while in the remaining 2 a combined approach was adopted. CONCLUSIONS: 80% of the patients subjected to a first laparoscopic approach needed a groin approach later on. 11% of the patients subjected to a first inguinal approach required laparascopic examination. In view of the results obtained, we conclude that inguinal exploration diminishes the need for second procedures.

[Therapeutic approach of enuresis based on the differentiation of the enuretic syndrome and monosymptomatic enuresis]. / Enfoque terapéutico de la enuresis basándose en la diferenciación del síndrome enurético y la enuresis monosintomática.

INTRODUCTION: Enuresis affects 15% of the children under 5. Possible etiopatogeny explaining the mechanism of production of nocturnal enuresis has been described, resulting in different terapeutical approaches; however, we cannot speak up to now of general guidelines for its treatment. MATERIALS AND METHODS: On the basis of 544 children who were treated in our hospital in the last 12 years, we analysed a sample of 124 patients corresponding to the last two years. We now present the therapeutical protocol used and analyse the results. In the initial therapeutical approach a distinction is made between monosymptomatic enuresis and eneuretic syndrome. RESULTS: We studied a total of 120 patients (89 boys and 31 girls). 63% of them showed monosymptomatic enuresis while 37% suffered from enuretic syndrome. In the case of 15% of them, this was associated with heavy sleep and difficulties to wake up. 92% was the general percentage of recovery. In the patients suffering from nonosymptomatic eneuresis, the problem was solved with desmopressin in 87% of them (demospressin on its own in 65% or in combination with oxibutine in the remaining 35%). In the group of enereutic symdrome, the problem was solved with oxibutine in 71% (on its own in 40% or in combination with desmopressin in 54%. CONCLUSIONS: The treatment and solution of enuresis improve the child's self-esteem and the anxiety caused in the family. A good medical history with a clear distinction between enuretic syndrome and monosyntomatic enuresis leads us to a suitable therapeutical approach for every patient, allowing us to find earlier the right treatment for every individual.

Corrección de las orejas procidentes mediante un abordaje mínimamente invasivo / Correction of lop ear using minimally invasive approach

Introducción. El hélix valgus u orejas procidentes es un problema común que afecta a un 5% de la población. Las alteraciones anatómicas del pabellón que más frecuentemente se encuentran son el defecto en el desarrollo de los pliegues de antehélix y el sobre desarrollo dela concha. Esta patología en los niños suele causar ansiedad y un trauma emocional que puede interferir en su desarrollo. Material y métodos. Existen múltiples técnicas descritas para la corrección del hélix valgus. Describimos la técnica realizada en nuestro servicio durante los últimos siete años analizando los resultados. Realizamos la otoplastia mediante un abordaje anterior puntiforme que nos permite realizar de una manera poco agresiva varios cortes parciales del cartílago por vía anterior. Por vía posterior realizamos la (..) (AU)

Introduction. Helix valgus or procident ears is a common problem that affects about 5% of the population. The folds of the antehelix and the overdevelopment of the concha are the most commonly found anatomic alterations of the ear pavilion. In children this pathology usually causes anxiety and an emotional trauma that may interfere in their normal development. Materials and methods. There are a few tipes of techniques to correct helix valgus. We present the application of the technique in our (..) (AU)

Testes no palpables: ¿abordaje laparoscópico o inguinal? / Non-Palpable testes: Laparoscopic or inguinal approach?

Introducción: El 20% de los pacientes intervenidos por criptorquidia presentan teste no palpable en la exploración física. El manejo inicial de estos pacientes sigue siendo controvertido. Nuestro objetivo es comparar el abordaje inguinal y el laparoscópico y valorar cuál de ellos es el más resolutivo como opción inicial. Material y métodos: Revisamos los pacientes intervenidos por teste no palpable unilateral en los últimos tres años en nuestro servicio. Tras descartar los testes no palpables bilaterales entramos en el estudio53 pacientes. En 35 el abordaje inicial realizado fue por vía inguinal y en 18 laparoscópico. Los datos recogidos para el estudio son la edad del paciente en el momento de la intervención, lado del teste no palpable, hallazgos quirúrgicos, necesidad de abordaje combinado laparoscópico o inguinaly presencia o no de hernia asociada. Resultados: La edad media de los pacientes en el momento de la intervención quirúrgica fue de 3,7 años (R: 1-13 años). El 42% de los testes no palpables correspondían al lado derecho y el 58% al izquierdo. El 65 % de los pacientes se abordaron inicialmente por vía inquinal. En tan sólo el 11% debido a una exploración no concluyente se necesitó realizar una exploración laparoscópica que concluyó en todos los casos anorquia. En el 33% el abordaje inicial fue laparoscópico. En (..) (AU)

Introduction: Twenty per cent of the operated patients suffering from cryptorchidisim show no palpable testis in the physical check-up. The use of a non-palpable testis in the initial stages is considered to be controversial when deciding between a laparascopic or an inguinal approach. Our aim is to compare the results obtained with these two approaches and evaluate which one of them would be the most relevant as an initial option. Materials and methods: We examined the patients who have been subjected to surgical intervention for non-palpable testis in the last three years. We had a sample of 53 patients. Bilateral non-palpable testes were disregarded. In the case of 35patients the initial approach was through the groins while in 18 of them the approach was laparascopic. Relevant data were recorded, such as the age of the patient, right or left side, surgical findings, need for alaparascopic or groin approach and associated hernia. Results: The average age of the patients at the time of the surgical treatment was 3.7 years R ( 1-13 years). 42% of the testes were on the right side and 58% on the left. In an initial stage the inguinal approach was used with 35 patients, 2 of these requiring laparascopic exploration due to a non-concluding check-up; it was concluded that they were 2 cases of anorchia. An initial laparoscopic approach (..) (AU)

[Bladder psoas hitch. Report of 11 cases]. / Psoización vesical. A propósito de 11 casos.

Bladder psoas hitch is an surgical technique which, in very complicated cases, like repeated failures of vesico-ureteral re-implants or undiversions, allow us to bridge the shortness of the ureter and obtain a good vesico-ureteral reimplant. The surgical maneuver is described and several of the 11 cases operated by this technique are commented. The results are presented.

[First infantile liver transplants in Spain]. / Primeros trasplantes hepáticos infantiles en España.

For the first time in Spain, authors report the experience, started by the Hospital Infantil "Valle de Hebron" of Barcelona on pediatric liver transplant in terminal liver disease in childhood which means a new opportunity for these patients otherwise facing a fatal out come in a short time. We show the 4 first pediatric liver transplants performed in our country and we point out some of the most important factors of a pediatric liver transplant program in a consolidation phase.

[Surgical treatment of pneumothorax in the newborn infant]. / Tratamiento quirúrgico del neumotórax en el recién nacido.

Tension pneumothorax refractory to thoracocentesis is a serious consequence of the greater refinements of neonatal intensive care. Various techniques have been recently proposed for solving this problem, such as selective intubation or surgical treatment. We present our experience with the surgical treatment of refractory pneumothorax compared to conservative methods. In the 3 operated cases a notable improvement of ventilatory conditions was observed without the need of posterior drainage.