[The anal plug in the treatment of fecal incontinence in myelomeningocele patients: results of the first clinical trial]. / El obturador anal en el tratamiento de la incontinencia fecal en el mielomeningocele: resultados del primer ensayo clínico.

OBJECTIVE: Ninety percent of patients with myelomeningocele are affected by urinary incontinence and more than 75% suffer fecal incontinence as well. For this reason, we carried out a clinical trial in order to demonstrate the performance of the anal plug. PATIENTS AND METHODS: The trial was carried out with 19 patients, 10 females and 9 males, between 3 and 26 years of age. Fecal incontinence was considered to be a problem in 94.7%. The anal plug used was made of polyurethane foam compressed by a polyvinyl alcohol foil that dissolves when exposed to warmth and moisture, expanding to its full size in 30-60 seconds. The anal plug is removed by pulling gently on a soft gauze string that is molded into the plug. RESULTS: The maximum time of having the anal plug in place was 12 hours. The reason for removal was due to routine change in 57.9% of the cases and in 21% the product slipped out, mainly during the adaptation and training period. Application of the anal plug was found to be very easy by 73.6% of the patients. The general evaluation was excellent to good in 78.9% of the users and 89.5% of the patients wished to continue using the product. CONCLUSIONS: Having clinically evaluated the effectiveness of the anal plug, we can conclude that the use of this product provides clear physical and psychological benefits. To date, it is the only non-surgical treatment for fecal incontinence available to those patients who desire to carry out a complete social life.

[Results of the conservative treatment of severe renal trauma in childhood]. / Resultados del tratamiento conservador del traumatismo renal grave en la infancia.

Surgical treatment of severe renal trauma usually ends in loss of high percentage of kidneys. In consequence of this, in the last decade several authors prefer a conservative management of kidneys severely injured. There include stabilization in Intensive Care Unit, with the goal of preservation the most possible functioning renal tissue. The purpose of this paper is to present the results of conservative management of severe renal trauma in our Center in the last five years. We conclude that this type of management is accurate and effective.

[Functional changes in the bladder of children with primary bladder diverticulum]. / Alteraciones funcionales de la vejiga en los niños portadores de divertículo vesical primario.

OBJECTIVE: Primary vesical diverticulum is generally diagnosed during urological evaluation for recurrent urinary tract infection that are frequently associated with the symptoms of urinary dysfunction. A urodynamic study was performed in children with primary vesical diverticulum to confirm or discard the presence of vesicourethal dysfunction, its relationship with vesicoureteral reflux, which is associated with diverticulum, and the results achieved by surgical versus medical treatment. METHODS/RESULTS: A urodynamic study was carried out in 11 children (7 boys and 4 girls), aged 6 to 13 years, with primary vesical diverticulum. The diverticulum was parameatal in 7 cases (4 with reflux), posterolateral in 2 cases (1 with reflux), anterolateral in 1 patient and 1 patient had multiple bladder diverticula without neurological disorder. Surgery was indicated in 8 cases and 3 were managed conservatively. Vesicourethral function, at the time the diverticulum was diagnosed, was normal in 3 (27%) and pathological in 8 (73%) patients. The urodynamic study disclosed uncoordinated vesicosphincteric function (4 pts), vesical instability (3 pts) and vesical hypotony (1 pt). Of these 4 cases with urodynamic disorders, diverticulum was associated with vesicoureteral reflux. Of the 8 children submitted to surgery, 6 had a functional pathology preoperatively; following surgical treatment of the diverticulum, vesicourethral function returned to normal in all cases. Of the 3 cases managed conservatively, 2 had persistent urodynamic disorders despite drug therapy; one of them had clinical features of urinary incontinence. CONCLUSIONS: These fundings suggest that alterations of bladder function might arise from the anatomic changes in the detrusor muscle causing the diverticulum and contribute to the onset or persistence of reflux, and should be considered an additional criterion for indicating surgery. It is therefore suggested that a urodynamic study for its diagnosis be included in the protocol for evaluation of children with primary vesical diverticulum.

[Retroperitoneal laparoscopic nephrectomy in children]. / Nefrectomía laparoscópica retroperitoneal en la infancia.

We present two cases of obstructive uropathy nefrectomy through a retroperitoneal approach was performed. Renal differential function by means of a 2,3 dimercapto-succinic acid renal scan showed less than 10% on the ipsilateral kidney to the diagnosis pathology. The size of the kidneys meant no hindrance during its nefrectomy. Morcellation within the organ bag was required for its removal without needing to broaden the 10 mm port opening. The patients were discharged home 48 hours after surgery and they returned to school within the first postoperative week.

[Multicystic renal dysplasia: changes in the contralateral urinary tract]. / Displasia renal multiquistica: alteraciones en el tracto urinario contralateral.

We have treated seven children with multicystic dysplastic kidney during the last 15 years. Three of then presented contralateral upper urinary tract anomalies. Four cases were diagnosed during prenatal period and three during the first term of life. We did analytic kidney function evaluation, ultrasound examination, voiding cystourethrography, radionuclide scan, gammagraphy, excretory urography and urinary cultures in all cases. We have found a vesicoureteral reflux with a bifid pelvis associated in the same child and two other cases with nonobstructive hydronephrosis. The child with vesicoureteral reflux presented also ipsilateral anomalies like a bladder diverticulum and an incomplete urethral duplication. One child with hydronephrosis opposite to the multicystic dysplastic kidney, also presented a bowel malrotation and a congenital cardiopathy, as extra-urologic associated anomalies.

[Therapeutic attitude in patients with multicystic dysplastic kidneys]. / Actitud terapéutica ante la displasia renal multiquística.

We presented seven multicystic dysplastic kidney cases treated in our Hospital during the last 15 years. Four children were diagnosed prenatally and three during the first term of life. Five were girls and two boys. We found three contralateral upper urinary tract anomalies. We did five nephrectomies. In two cases because compressive abdominal mass during the neonatal period, in two cases during the first year of life because symptomatic urinary tract infections and one case at the age of 13 months with persistent multicystic dysplastic kidney followed by ultrasound. Two cases were not operated. In one patient with partial regression of the multicystic kidney the family refused operation. We have lost follow-up in the last patient.

[Indications for urodynamic studies in childhood: our experience with 214 surgical patients]. / Indicaciones del estudio urodinámico en la infancia: nuestra experiencia en 214 pacientes quirúrgicos.

Between 1983 and 1994, 515 pediatric patients with medical and/or surgical problems underwent urodynamic evaluation. We present the urodynamic findings of 214 children with surgical pathology: 73 cases with vesicoureteral reflux, 26 with urethral stricture, 11 with posterior urethral valves and 104 cases with lipo- and myelomeningocele. We found a high incidence of urodynamic abnormalities associated to these pathologies: 46.5 in patients with vesicoureteral reflux, 88.4% in urethral strictures, 54.4% in posterior urethral valves and 100% in patients with spina bifida. In our opinion, the urodynamic assessment has a contributory role in the indication for corrective surgery; because the knowledge of the vesicourethral complex state will help to stabilize it through a correct individualized medical treatment before surgical treatment, delaying or even avoiding surgery in some cases.

[Urinary retention in a child secondary to urethral uric lithiasis]. / Retención urinaria en el niño secundaria a litiasis úrica uretral.

Urinary lithiasis in children is less frequent than in adults. The incidence of uric acid lithiasis in adult population is between 5 to 39% of all lithiasis. Only a third part of the urinary calculi in infancy are compound of uric acid. The most frequent uric lithiasis is that so called endemic. Usually appears in the lower urinary tract and it is not related to metabolic disturbances. We present the exceptional case of an Arabian boy 4 years old who came to the Hospital because he suffered urinary retention secondary to the fixation of uric acid stone in bulbous urethra. The treatment performed was the external urethrotomy and we could removed the stone. We emphasize that the postoperative control was done by uroflowmetry. After one year, the result is satisfactory.

[Urodynamic study of bladder dysfunction in recurrent vesico-ureteral reflux]. / Diagnóstico urodinámico de la disfunción vesical en el reflujo vesicoureteral recidivante.

In the last 5 years we have treated in our service 98 patients suffering vesicoureteral reflux (VUR) with 148 refluyents units (RU) in total. The VUR recurred in 9 ureters (6.08%) in children neurologically normal. A urodynamic study was made in them getting the following diagnosis, in 5 R. U. vesical dysfunction: 4 R. U. vesico-sphinteric dyssynergia and in 1 R. U. vesical hyperreflexia with uninhibited bladder contractions. In the remaining 4 R. U. the urodynamic study was normal.

Yolk sac tumor of the testicle: is retroperitoneal lymph node dissection necessary?

We report our experience with 11 cases of yolk sac tumors, which were treated between 1960 and 1982 at the Hôpital Sainte-Justine and the Montreal Children's Hospital. The role of lymphadenectomy in yolk sac tumors is analyzed critically and put into perspective with the use of serum alpha-fetoprotein. A flow sheet is presented for the management of yolk sac tumors. It seems that the indication for lymphadenectomy in yolk sac tumor should be restricted to patients with persistently elevated serum alpha-fetoprotein after inguinal orchiectomy and chemotherapy.