Outcomes of pediatric living donor kidney transplantation: A single-center experience.

Renal transplantation is the treatment of choice for children with ESRD offering advantages of improved survival, growth potential, cognitive development, and quality of life. The aim of our study was to compare the outcomes of LDKT vs DDKT performed in children at a single center. Retrospective chart review of pediatric patients who underwent kidney transplantation from 2005 to 2014 was performed. Ninety-one renal transplants were accomplished, and 31 cases (38.27%) were LDKT, and in 96.7% of the cases, the graft was obtained through laparoscopy. Thirty-four receptors weighted <25 kg. LDKT group had statistically significant lower cold ischemia times than DDKT one. Complication rate was 9.67% for LDKT and 18.33% for DDKT. eGFR was better in LDKT. Patient survival rate was 100% for LDKT and 98.3% for DDKT, and graft survival rate was 96.7% for LDKT and 88.33%-80% for DDKT at a year and 5 years. Our program of pediatric kidney transplantation has achieved optimal patient and graft survival rates with low rate of complications. Living donor pediatric kidney transplants have higher patient and better graft survival rates than deceased donor kidney transplants.

Ectopic Vas Deferens Inserting Into Distal Retroiliac Ureter in the Currarino Syndrome.

Vas deferens ectopia is a rare congenital anomaly frequently associated with anorectal abnormalities and hypospadias. We present a Currarino syndrome case with an ectopic vas deferens terminating in a distal retroiliac ureter. A left vasectomy, ureteral decussation over the iliac vessels, and a Cohen's-type ureteral reimplantation were performed. The objectives are to preserve renal function, prevent epididymitis, and preserve fertility. There is no evidence in the literature that recommends surgical correction of the vas deferens. Microsurgical epididymal sperm aspiration or testicular sperm extraction combined with intracytoplasmic sperm injection might be a viable strategy for these affected individuals.

[The efficacy of endoscopic treatment for secondary vesicoureteral reflux. Analysis of a series of 142 cases]. / Eficacia del tratamiento endoscópico del reflujo vesicoureteral secundario. Analisis de una serie de 142 casos.

OBJECTIVES: To evaluate the rate of secondary or complicated vesicoureteral reflux (VUR) among the total number of VUR cases treated in our institution. To determine the efficacy of the endoscopic treatment in secondary or complicated VUR depending on etiology and grade. METHOD: We review our experience with endoscopic treatment for VUR from 1992 to 2006. We have used three different materials: polytetrafluoroethylen (Teflon), polydimethyls iloxane (Macroplastique) and dextranomer/hyaluronic acid copolymer (Deflux). 479 ureters with VUR were treated in 402 patients; 124 patients and 142 ureters of them were secondary or complicated VUR cases. All patients were followed up with urinary tract ultrasound and radiological or isotopic voiding cystogram. Success is defined as VUR disappearance or improvement to grade I VUR without urinary infection after removing antibiotic prophylaxis. RESULTS: The success rate has been 71.13% after the first injection, 85.92% after the second injection and 90.14% after the third injection. Mean subureteral dose has been 0.65 ml. The complications rate has been 0%. CONCLUSIONS: The endoscopic treatment in secondary or complicated VUR is a minimally invasive procedure. It seems to be more difficult than in primary VUR cases, but its low morbidity and efficacy indicate this may be a proper first option in selected patients. In cases of VUR secondary to neurogenic bladder dysfunction it seems to be less successful, probably because of a worse control of the high bladder pressure.

[Vesicoureteral reflux after pediatric kidney transplantation]. / Reflujo vesicoureteral tras trasplante renal en la edad pediátrica.

OBJECTIVES: We analyze the frequency of vesicoureteral reflux and the factors that favor its appearance after kidney transplantation in pediatric patients. METHODS: This retrospective analysis examined the prevalence of posttransplant vesicoureteral reflux in a total of 201 kidney transplants performed in children at our centre between 1978 and 2006. In patients who required corrective surgery for this problem, we analyzed pretransplant residual diuresis, pretransplant pathology and posttransplant problems related to vesicoureteral reflux. We also analyzed the form of presentation, whether reflux was to the graft or to the native kidney, degree of reflux, and surgical technique used to correct reflux. RESULTS: Twelve patients (5.9%) needed surgery to correct reflux to the graft (10 children) or to the native kidney (2 children). Reflux presented as urinary tract infection in 11 children and progressive graft failure in 1. Urethrovesical disorders that favoured vesicoureteral reflux were present in 10 patients (noncompliant bladder, detrusor overactivity, posterior urethral valves, urethral stenosis). Lengthening the submucosal tunnel stopped urinary tract infections in all 12 patients, whereas 6-month voiding cystourethrograms showed resolution in 10 patients and reduction in the degree of reflux in 2. CONCLUSION: The high percentage of posttransplant vesicoureteral reflux in pediatric patients was related with higher frequency of vesicourethral pathology in children who received the transplant. In children with pretransplant urethrovesical anomalies we recommend an initial technique which utilizes a longer submucosal tunnel during implantation, such as the Lich-Gregoir.

Eficacia del tratamiento endoscópico del reflujo vesicoureteral secundario. Análisis de una serie de 142 casos / The efficacy of endoscopic treatment for secondary vesicoureteral reflux. Analysis of a series of 142 cases

Objetivo: Analizar la proporción de reflujos vesicoureterales secundarios o complicados del total de reflujos vesicoureterales tratados en nuestro centro. Determinar la eficacia del tratamiento endoscópico en dicho tipo de reflujo según la etiología que lo produce y según el grado. Método: Revisamos nuestra serie desde que iniciamos el tratamiento endoscópico del reflujo en el año 1992 hasta diciembre del 2006, empleando tres materiales distintos: pasta de politetrafluoroetileno (Teflon®), polidimetilsiloxano (Macroplastique®) y dextranómero-copolímero de ácido hialurónico (Deflux®). Hemos tratado a 402 pacientes y 479 unidades excretoras, de los que 124 pacientes y 142 unidades excretoras correspondían a una etiología secundaria. Se han seguido de forma sistemática mediante ecografía y CUMS o cistografía isotópica. Definimos el éxito del tratamiento como la desaparición del RVU o el descenso a grado I sin ITU tras retirar la profilaxis antibiótica. Resultados: Se resolvieron en el primer intento el 71,13% de los reflujos secundarios, mejorando al 85,92% en el segundo intento y al 90,14% en el tercero. El volumen medio inyectado ha sido de 0,65 ml. La tasa de complicaciones ha sido del 0%. Conclusiones: El tratamiento endoscópico del reflujo vesicoureteral secundario es un procedimiento minimamente invasivo, que puede realizarse en regimen ambulatorio, técnicamente algo más difícil que en los casos de reflujo vesicoureteral primario, pero con muy baja morbilidad y muy eficaz en casos seleccionados, por lo que pensamos que debe ser considerado la primera opción de tratamiento. La menor eficacia la hemos obtenido en los casos de reflujos secundarios a vejiga neurógena, probablemente en relación a un mal control de las altas presiones vesicales (AU)

Objectives: To evaluate the rate of secondary or complicated vesicoureteral reflux (VUR) among the total number of VUR cases treated in our institution. To determine the efficacy of the endoscopic treatment in secondary or complicated VUR depending on etiology and grade. Method: We review our experience with endoscopic treatment for VUR from 1992 to 2006. We have used three different materials: polytetrafluoroethylen (Teflon®), polydimethylsiloxane(Macroplastique®) and dextranomer/hyaluronic acid copolymer (Deflux®). 479 ureters with VUR were treated in 402 patients ; 124 patients and 142 ureters of them were secondary or complicated VUR cases. All patients were followed up with urinary tract ultrasound and radiological or isotopic voiding cystogram. Success is defined as VUR disappearance or improvement to grade I VUR without urinary infection after removing antibiotic prophylaxis. Results: The success rate has been 71.13% after the first injection, 85.92% after the second injection and 90.14% after the third injection. Mean subureteral dose has been 0.65 ml. The complications rate has been 0%. Conclusions: The endoscopic treatment in secondary or complicated VUR is a minimally invasive procedure. It seems to be more difficult than in primary VUR cases, but its low morbidity and efficacy indicate this may be a proper first option in selected patients. In cases of VUR secondary to neurogenic bladder dysfunction it seems to be less successful, probably because of a worse control of the high bladder pressure (AU)

Reflujo vesicoureteral tras trasplante renal en la edad pediátrica / Vesicoureteral reflux after pediatric kidney transplantation

Objetivo: Analizamos la frecuencia de reflujo vesicoureteral tras trasplante renal (TR) en edad pediátrica y los factores que lo favorecen. Métodos: Entre 1978 y 2006 se realizaron en nuestro centro 201 TR pediátricos. En un análisis retrospectivo se revisó la prevalencia de RVU postrasplante. En aquellos que precisaron cirugía correctora de RVU postrasplante se analizó: diuresis residual pretrasplante, patología previa al TR o adquirida tras éste relacionada con RVU. Además se analizó forma de presentación, si el reflujo era al injerto o a los riñones nativos, grado de éste y técnica quirúrgica empleada para corregirlo. Resultados: Doce pacientes (5,9%) precisaron cirugía antireflujo. En 10 el reflujo fue al injerto y en 2 al riñón nativo. El reflujo se presentó como infección del tracto urinario (ITU) en 11 casos y deterioro progresivo de la función del injerto en 1. En 10 pacientes se detectó patología uretrovesical favorecedora de reflujo vesicoureteral (vejigas no compliantes, hiperactividad del detrusor (HDD), válvulas de uretra posterior (VUP), estenosis de uretra, etc..). Tras ampliación del túnel submucoso desaparecieron las ITU en los 12 casos, mientras que la C.U.M.S a los 6 meses mostró resolución en 10 casos y disminución del grado de reflujo en 2. Conclusión: El mayor porcentaje de reflujo vesico-ureteral postrasplante en la edad pediátrica, se relaciona con la mayor frecuencia de patología uretrovesical en los niños receptores del trasplante. La realización de un túnel submucoso más amplio durante el implante, en aquellos niños con patología uretrovesical pretrasplante, podría reducir el porcentaje de esta complicación (AU)

Objectives: We analyze the frequency of vesicoureteral reflux and the factors that favor its appearance after kidney transplantation in pediatric patients. Methods: This retrospective analysis examined the prevalence of posttransplant vesicoureteral reflux in a total of 201 kidney transplants performed in children at our centre between 1978 and 2006. In patients who required corrective surgery for this problem, we analyzed pretransplant residual diuresis, pretransplant pathology and posttransplant problems related to vesicoureteral reflux. We also analyzed the form of presentation, whether reflux was to the graft or to the native kidney, degree of reflux, and surgical technique used to correct reflux. Results: Twelve patients (5.9%) needed surgery to correct reflux to the graft (10 children) or to the native kidney (2 children). Reflux presented as urinary tract infection in 11 children and progressive graft failure in 1. Urethrovesical disorders that favoured vesicoureteral reflux were present in 10 patients (noncompliant bladder, detrusor overactivity, posterior urethral valves, urethral stenosis). Lengthening the submucosal tunnel stopped urinary tract infections in all 12 patients, whereas 6-month voiding cystourethrograms showed resolution in 10 patients and reduction in the degree of reflux in 2. Conclusion: The high percentage of posttransplant vesicoureteral reflux in pediatric patients was related with higher frequency of vesicourethral pathology in children who received the transplant. In children with pretransplant urethrovesical anomalies we recommend an initial technique which utilizes a longer submucosal tunnel during implantation, such as the Lich-Gregoir (AU)

Vesicoureteral reflux after kidney transplantation in children.

We analyzed the frequency of vesicoureteral reflux and the factors that favor its appearance after kidney transplantation in pediatric patients. This retrospective analysis examined the prevalence of post-transplant vesicoureteral reflux in a total of 181 kidney transplants performed in children at our center between 1978 and 2004. In patients who required corrective surgery for this problem, we analyzed pretransplant residual diuresis, pretransplant pathology and post-transplant problems related to vesicoureteral reflux. We also analyzed form of presentation, whether reflux was to the graft or to the native kidney, degree of reflux, and surgical technique used to correct reflux. Ten patients (5.5%) needed surgery to correct reflux to the graft (nine children) or to the native kidney (one child). Reflux was manifested as urinary tract infection in six children and progressive graft failure in one. Urethrovesical disorders that favored vesicoureteral reflux were present in eight patients (non-compliance bladder, detrusor overactivity, posterior urethral valves, urethral stenosis). Lengthening the submucosal tunnel stopped urinary tract infections in all 10 patients, whereas six-month voiding cystourethrograms showed resolution in 8 patients and (only) reduction in the degree of reflux in two. The high percentage of post-transplant vesicoureteral reflux in pediatric patients were related with higher frequencies of ureterovesical pathology in children who received the transplant. Lengthening the submucosal ureteral tunnel vesicoureteral reflux was corrected in 80%. We recommend during implantation in children with pretransplant urethrovesical abnormality an initial technique, which utilizes a longer submucosal tunnel such as the Lich-Gregoir.

[Arterial priapism in a prepuberal patient. Conservative treatment]. / Priapismo arterial en paciente prepúber. Tratamiento conservador.

OBJECTIVES: To report the case of a 7-year-old patient with high flow priapism solved with conservative treatment. METHODS: We performed history and physical examination, complementary tests including general blood tests (serum ions, hemogram and coagulation tests), peripheral blood smear, Doppler ultrasound and selective arteriography which led to the diagnosis of high flow priapism. Due to the absence of arteriovenous fistula conservative treatment was chosen. RESULTS: Patient improved clinically after five days, with penile detumescence and spontaneous erections were preserved. CONCLUSIONS: Conservative treatment is a valid option in patients with arterial priapism, mainly in those cases in whom performing embolization of a small fistula seen on arteriography is not possible or when such AV communication is not demonstrated.

Evolution of the treatment of vesicoureteral reflux in Spain.

PURPOSE: We determined the changes in the treatment of vesicoureteral reflux (VUR) at children's hospitals in Spain as well as the long-term results of endoscopic treatment (ET) with polytetrafluoroethylene, namely with STING (subureteral polytetrafluoroethylene injection). MATERIALS AND METHODS: A survey was performed of all pediatric urology units in Spain to determine changes in the diagnosis and treatment of VUR in the last 10 years. Also, a conjoint study was made of STING case records at 5 Spanish hospitals where there is expertise in the technique. RESULTS: The response rate was 34 of 44 cases (78%). The most significant changes were the introduction of urodynamics and the progressive establishment of ET as a substitute for open surgery and prolonged medical treatment. At more than 90% of the units ET is now done with different materials with a cure rate of 75% after 1 injection and a low index of complications. The results of the STING study in 2,035 refluxing ureters showed a cure rate of about 90% for 2 or 3 injections for grades I to IV reflux and just under 70% for grade V. Also, the cure rate for complex reflux was 60% and the index of complications was less than 1.2% with some intravesical migration. CONCLUSIONS: There have been many changes in the approach to VUR with an increasing use of urodynamics and ET. Since the long-term results of STING are reliable and no long-term complications have been observed, polytetrafluoroethylene appears to be the product with the best quality/price ratio for use in ET. However, it is being replaced.