[Surgical treatment of hypospadias and complications in relation to the child's age]. / Tratamiento quirúrgico del hipospadias y sus complicaciones en relación con la edad del niño.

BACKGROUND: Hypospadias is one of the most common congenital malformations. Few studies have explored the association of age at time of surgery and the occurrence of complications after hypospadias repair. OBJECTIVE: Determine whether age at hypospadias repair is a risk factor for development of complications. METHODS: Retrospective cohort of patients with hypospadias repair in one surgical time. The data included: age, type of hypospadias, surgical technique and complications presented. The monitoring was conducted for six months after the surgery. Patients were classified according to age group A less than 24 months, group B from 24 to 48 months and group C over 48 months. We calculated the relative risk and confidence intervals of 95%. RESULTS: 170 patients were included in the analysis. The incidence of complications was 24.1%, the most frequent complication was urethrocutaneous fistula (52.2%). The median age in months of the complication group was 40.8 (6-196), whereas in the group without complications was 37.5 (6-196). Age was not associated with an increased risk for complications, group B (RR= 0.975 [95% CI 0.374-2.547]), and group C (RR= 0.966 [95% CI 0.386-2.416]) when compared with group A. CONCLUSIONS: Age at time of surgery for hypospadias correction in one phase is not associated with complications.

Antecedentes: el hipospadias es una de las malformaciones congénitas más comunes. Pocos estudios han explorado la asociación de la edad al momento de la cirugía y las complicaciones. Objetivo: determinar si la edad al momento de la corrección del hipospadias es un factor de riesgo de complicaciones. Material y métodos: estudio de cohorte retrospectiva de pacientes con reparación del hipospadias en un tiempo quirúrgico. Los datos incluyeron: edad, tipo de hipospadias, técnica quirúrgica y complicaciones. El seguimiento se efectuó incluso seis meses después de la cirugía. Los pacientes se clasificaron según su edad: el grupo A menores de 24 meses, grupo B de 24 a 48 meses y el grupo C mayores de 48 meses. Se calculó el riesgo relativo y los intervalos de confianza de 95%. Resultados: se analizaron los expedientes de 170 pacientes. La incidencia de complicaciones fue de 24.1%, la más frecuente fue la fistula uretrocutánea (52.2%). La mediana de edad en meses del grupo con complicación fue: 40.8 (6-196), mientras que en el grupo sin complicación fue: 37.5 (6-196). La edad no se asoció con mayor riesgo de complicaciones, grupo B (RR= 0.975 [IC 95% 0.374-2.547]); y el grupo C (RR= 0.966 [IC 95% 0.386-2.416]) al compararla con el grupo A. Conclusiones: la edad al momento de la corrección del hipospadias en un tiempo quirúrgico no se asocia con complicaciones quirúrgicas.

Screening for Chlamydia trachomatis infection in pregnant women in Martinique.

GOAL OF THIS STUDY: To determine the prevalence of Chlamydia trachomatis urogenital infection and to identify behavioral, demographic, and clinical factors associated with the infection in pregnant women in Martinique. STUDY DESIGN: One-thousand-four-hundred-eleven patients 15-39 years old, at 10-16 weeks of gestation and attending the prenatal clinic at Lamentin Hospital, were tested for Chlamydia trachomatis infection of the cervix and urethra using tissue culture. RESULTS: Chlamydia trachomatis was isolated from 375 (26.7%) women; 34% of them were positive in the cervix and urethra, 58% in the cervix only, and 8% in the urethra only. Factors found by multivariate analysis to be significantly associated with chlamydial infection were age less than 25 years, first intercourse at less than 18 years old, previous induced abortions, mucopurulent cervicitis, and repeated candidiasis. CONCLUSIONS: None of the factors associated with chlamydial infection was sensitive enough to permit efficient selective screening. It is cost effective to recommend a routine screening for chlamydial infection together with an educational program.

PIP: To determine the prevalence of Chlamydia trachomatis urogenital infection among pregnant women in Martinique, 1411 consecutive women presenting to Lamentin Hospital for their initial prenatal visit between 1988-90 underwent specimen collection and extensive interviews. The mean age of study subjects was 27.1 years and the mean number of life-time sex partners was 3.2. C. trachomatis was isolated from 375 women (26.7%), two-thirds of whom were asymptomatic. There was an inverse correlation between age and infection rate; 164 (43.7%) infected women were under 25 years of age. 34% had evidence of infection in both the cervix and urethra, 58% in the cervix only, and 8% in the urethra only. Other sexually transmitted pathogens with a high prevalence in this group included Ureaplasma urealyticum (39.9%), Candida albicans (32%), and Trichomonas vaginalis (13.7%). Factors that correlated significantly with chlamydia infection by multivariate analysis were age less than 25 years, first intercourse less than 18 years, previous induced abortion, cervicitis, and repeated candidiasis. However, no single risk factor or constellation of risk factors was sufficiently sensitive to form the basis of a selective screening program. Considering the serious maternal and infant complications of C. trachomatis infection, routine screening in pregnant women is urged. Given a prevalence rate of 27%, 1630 infected pregnant women should be identified each year in Martinique. The cost of screening and treating these women and their partners would be US$250,000 compared to $1.2 million required to treat chlamydia-related conjunctivitis and pneumonia in infants and postpartum salpingitis in mothers.

Fibromyalgia associated with female urethral syndrome.

Thirty-eight out of 212 patients (18%) with fibromyalgia met the criteria for the definition of female urethral syndrome (FUS). None of the patients from the control group met these criteria. The treatment for FUS was the same as that for fibromyalgia: cyclobenzaprine or diazepam and nonsteroidal anti-inflammatory drugs with a partial response in both pathologies. We should consider FUS in the evaluation of every patient with fibromyalgia.

Prolapse of the urethral mucosa in prepubertal West Indian girls.

Forty-two cases of urethral mucosal prolapse were reviewed in Trinidad, West Indies. The main presenting symptom was vaginal bleeding; 31% of patients had associated infection and 97% belonged to social classes III to V; 33% had conservative management and 67% had surgical treatment. It was concluded that treatment should be medical rather than surgical and it is suggested that this is a disease of the low socio-economic group.

Prolapse of the urethral mucosea in prepubertal West Indian girls

Forty-two cases of urethral mucosal prolapse were reviewed in Trinidad, West Indies. The main presenting symptom was vaginal bleeding; 31 percent of patients had associated infection and 97 percent belonged to social classes III to V; 33 percent had conservative management and 67 percent had surgical treatment. It was concluded that treatment should be medical rather than surgical and it is suggested that this is a disease of the low socio-economic group (AU)