Use of internal-external diversion stent in open pyeloplasty in patients under one year of age. / Uso de catéter de derivación interno-externo en la pieloplastia abierta en menores de un año.

INTRODUCTION: There are various alternatives available for renal pelvis drainage following pyeloplasty. One of them is the use of an internal-external diversion stent, which according to our protocol, is knotted 48 hours following surgery, prior to discharge, and removed 7 days later on an outpatient consultation basis, with no sedation or analgesia required. OBJECTIVE: To analyze the results of patients under one year of age who underwent open pyeloplasty associated with an outpatient internal-external diversion stent. MATERIALS AND METHODS: A retrospective, descriptive analysis of 28 patients (31 renal units) undergoing surgery from 2011 to 2021 was carried out. Diagnostic methods, indications, surgical approach, and postoperative progression were assessed. RESULTS: 28 patients (23 male) prenatally diagnosed with hydronephrosis confirmed by ultrasonography and/or renogram underwent pyeloplasty at a median age of 3 months (15 days-11 months). Pyeloplasty was conducted according to the Anderson-Hynes technique or dismembered pyeloplasty in 28 renal units, and according to the Culp-DeWeerd technique or spiral flap in 3. In all cases, an internal-external diversion stent was used according to our protocol. Mean hospital stay was 3.5 days (2-7 days), with a good postoperative progression. 2 patients had complications (urinary infection requiring intravenous antibiotics, and pyonephrosis requiring re-pyeloplasty). CONCLUSIONS: Using an internal-external diversion stent following pyeloplasty in patients under 1 year of age with ureteropelvic junction obstruction is a simple and safe option that allows for early discharge with outpatient management. It also avoids a second general anesthesia for drainage catheter removal purposes.

INTRODUCCION: Existen diversas alternativas para el drenaje de la pelvis renal tras una pieloplastia. Una de ellas es la utilización de un catéter de derivación interno-externo que, según nuestro protocolo, se anuda a las 48 horas posoperatorias previas al alta y se retira a los siete días de forma ambulatoria en consulta, sin necesidad de sedoanalgesia. OBJETIVO: Analizar los resultados de los pacientes menores de un año intervenidos mediante pieloplastia abierta, asociando un catéter de derivación interno-externo de manejo ambulatorio. MATERIAL Y METODOS: Análisis descriptivo retrospectivo de 28 pacientes (31 unidades renales) intervenidos entre los años 2011 y 2021. Se evaluaron métodos diagnósticos, indicaciones, abordaje quirúrgico y evolución posoperatoria. RESULTADOS: Veintiocho pacientes (23 varones) con diagnóstico prenatal de hidronefrosis confirmado con ecografía y/o renograma, fueron intervenidos mediante pieloplastia a una mediana de edad de tres meses (15 días-11 meses). Se realizó pieloplastia según técnica de Anderson-Hynes o pieloplastia desmembrada en 28 unidades renales y según técnica de Culp-DeWeerd o colgajo en espiral en 3. En todos los casos se utilizó un catéter de derivación interno-externo según protocolo. El tiempo medio de ingreso fue 3,5 días (2-7 días) con buena evolución posoperatoria. Dos pacientes presentaron complicaciones (infección urinaria que requirió antibioterapia intravenosa y pionefrosis que requirió repieloplastia). CONCLUSIONES: Asociar un catéter de derivación interno-externo a la pieloplastia en pacientes menores de un año con estenosis de la unión pieloureteral es una opción sencilla y segura que permite un alta precoz con manejo ambulatorio y evita una segunda anestesia general para la retirada del catéter de drenaje.

Uso de catéter de derivación interno-externo en la pieloplastia abierta en menores de un año / Use of internal-external diversion stent in open pyeloplasty in patients under one year of age

Introducción: Existen diversas alternativas para el drenaje de la pelvis renal tras una pieloplastia. Una de ellas es la utilización de un catéter de derivación interno-externo que, según nuestro protocolo, se anuda a las 48 horas posoperatorias previas al alta y se retira a los siete días de forma ambulatoria en consulta, sin necesidad de sedoanalgesia. Objetivos: Analizar los resultados de los pacientes menores de un año intervenidos mediante pieloplastia abierta, asociando un catéter de derivación interno-externo de manejo ambulatorio. Material y métodos: Análisis descriptivo retrospectivo de 28 pacientes (31 unidades renales) intervenidos entre los años 2011 y 2021. Se evaluaron métodos diagnósticos, indicaciones, abordaje quirúrgico y evolución posoperatoria. Resultados: Veintiocho pacientes (23 varones) con diagnóstico prenatal de hidronefrosis confirmado con ecografía y/o renograma, fueron intervenidos mediante pieloplastia a una mediana de edad de tres meses (15 días-11 meses). Se realizó pieloplastia según técnica de Anderson-Hynes o pieloplastia desmembrada en 28 unidades renales y según técnica de Culp-DeWeerd o colgajo en espiral en 3. En todos los casos se utilizó un catéter de derivación interno-externo según protocolo. El tiempo medio de ingreso fue 3,5 días (2-7 días) con buena evolución posoperatoria. Dos pacientes presentaron complicaciones (infección urinaria que requirió antibioterapia intravenosa y pionefrosis que requirió repieloplastia). Conclusiones: Asociar un catéter de derivación interno-externo a la pieloplastia en pacientes menores de un año con estenosis de la unión pieloureteral es una opción sencilla y segura que permite un alta precoz con manejo ambulatorio y evita una segunda anestesia general para la retirada del catéter de drenaje.(AU)

Introduction: There are various alternatives available for renal pelvis drainage following pyeloplasty. One of them is the use of an internal-external diversion stent, which according to our protocol, is knotted 48 hours following surgery, prior to discharge, and removed 7 days later on an outpatient consultation basis, with no sedation or analgesia required. Objective: To analyze the results of patients under one year of age who underwent open pyeloplasty associated with an outpatient internalexternal diversion stent. Materials and methods: A retrospective, descriptive analysis of 28 patients (31 renal units) undergoing surgery from 2011 to 2021 was carried out. Diagnostic methods, indications, surgical approach, and postoperative progression were assessed. Results: 28 patients (23 male) prenatally diagnosed with hydronephrosis confirmed by ultrasonography and/or renogram underwent pyeloplasty at a median age of 3 months (15 days-11 months). Pyeloplasty was conducted according to the Anderson-Hynes technique or dismembered pyeloplasty in 28 renal units, and according to the Culp-DeWeerd technique or spiral flap in 3. In all cases, an internal-external diversion stent was used according to our protocol. Mean hospital stay was 3.5 days (2-7 days), with a good postoperative progression. 2 patients had complications (urinary infection requiring intravenous antibiotics, and pyonephrosis requiring re-pyeloplasty). Conclusions: Using an internal-external diversion stent following pyeloplasty in patients under 1 year of age with ureteropelvic junction obstruction is a simple and safe option that allows for early discharge with outpatient management. It also avoids a second general anesthesia for drainage catheter removal purposes.(AU)

[Seromuscular colocystoplasty lined by urothelium. Experimental study in rats]. / Colocistoplastia seromuscular recubierta de urotelio. Un estudio experimental en ratas.

OBJECTIVE: To determine what technical of vesical extension in rat can offer the best functional and histological results. DESIGN: Comparative experimental study between pre and postoperative parameters of 60 female Wistar rats. The animals were divided in 5 groups using different techniques of vesical augmentation. Sham, colocystoplasty (CC), demucosalised colocystoplasty (DCC), demucosalised colocystoplasty lined by urothelium (AADCC), autoaugmentation (AA). INTERVENTIONS: Preoperative cystometrical study. Microsurgery for vesical augmentation. New cystometric study at the month, previous to the sacrifice of the animal and extraction of bladder for its histological study. Measurement of the volume and pressure of rupture. RESULTS: The technique of seromuscular enterocistoplasty presents the high mortality in the rat (63.6%). The increase of the vesical volume in both groups that carried seromuscular grafts was little (0.22 +/- 0.5 and 0.47 +/- 0.3 ml) in front of the control group (0.11 +/- 0.4 ml). Only standard colocystoplasty and bladder autoaugmentation produced significant increases on vesical volume (0.78 +/- 0.5 and 0.69 +/- 0.6 ml, respectively) and rupture volume. There were not observed significant differences on vesical rupture pressure.

[CO(2) laser treatment of sialolithiasis]. / Tratamiento de la sialolitiasis con láser de CO(2).

Sialolithiasis of the submaxillary gland is rare in the pediatric population. We report the case of a 13-year-old boy who presented submandibular tumefaction of 7 months evolution, which increased after meals. Localized lithiasis in Wharton s duct was observed in submaxillary sialolithiasis. Treatment was intraoral extraction with CO(2) laser and after recovering from the anesthetic, the patient was discharged.This technique shortens surgical time, facilitates hemostasia and reduces edema and postoperative pain. The procedure is suitable for ambulatory surgery.

[Poisoning by viper bites in children]. / Intoxicación por mordedura de víbora en niños.

Our experience with 36 cases of adder bites, collected during 13 years (1976-1989), is presented. The severity of the clinical picture was minimal to moderate in most of the cases, with mainly local symptomatology noted. Only 4 of the cases had symptoms such as vomiting and abdominal pain. Good results wee obtain in all cases with the prescribed medical treatment, except in one case which had partial necrosis of the skin on one finger on the side of viper bite. Antibiotics were used in all cases except three and anti-tetanus therapy was used in those cases where needed. Corticosteroids and antihistamines were used on selected occasions. We recommend the use of antiofidic serum, although the possibilities of anaphylactic reaction must be noted. We do not recommended local incisions and suction for this type of bites.