Vesicoureteral reflux in patients diagnosed with pyeloureteral junction obstruction. Is screening justified? / Reflujo vesicoureteral en pacientes diagnosticados de estenosis de la unión pieloureteral. ¿Está justificado el screening?

INTRODUCTION: The prevalence of vesicoureteral reflux (VUR) concomitant with pyeloureteral junction obstruction (PUJO) ranges from 5.2% to 18%. Today, there is no consensus on whether routine screening should be performed or not to rule out reflux, and it can be limited to selected patients. OBJECTIVES: To study VUR prevalence in patients diagnosed with PUJO, estimate reflux levels in patients with positive study, and limit serial voiding cystourethrogram (SVCU) or ultrasound cystography to selected patients (dilated ureter at ultrasound imaging and previous UTI). MATERIALS AND METHODS: Observational, retrospective study carried out in 74 patients undergoing surgery for PUJO. Information on sex, preoperative VUR screening, results (positive or negative for VUR), and reflux levels was collected. RESULTS: 53 cases (71.6%) were male and 21 (28.4%) were female. Reflux screening was performed in 55 patients (74.3%), vs. 18 (24.3%) where no study was carried out. 16.2% of cases with VUR preoperative study were managed using ultrasound cystography. The preoperative study was positive in 6 out of the 73 patients (1 patient was excluded after being diagnosed with posterior urethral valves), which means VUR prevalence in patients already diagnosed with PUJO was 10.7%. Of the six cases, one case was grade I, two cases were grade II, one case was grade III, one case was grade IV, and one case was grade V. CONCLUSIONS: VUR has a slightly higher incidence in patients diagnosed with pyeloureteral junction obstruction than in the general population. Routine screening of vesicoureteral reflux is unnecessary, unless in case of previous urinary infection, dilated ureter at ultrasound imaging, or suspected secondary cause.

INTROUCCION: La concomitancia entre la estenosis de la unión pieloureteral (EPU) y el reflujo vesicoureteral (RVU) se sitúa entre el 5,2 y el 18%. Actualmente, no existe consenso sobre la realización de screening rutinario para descartar dicho reflujo, pudiendo limitarlo a pacientes seleccionados. OBJETIVOS: Estudiar la prevalencia del RVU en los pacientes diagnosticados de EPU. Estimar el grado de reflujo en aquellos pacientes con estudio positivo. Limitar la realización de cistouretrografía miccional seriada CUMS o de ecocistografía a pacientes seleccionados (uréter dilatado visible en ecografía, ITU previa). MATERIAL Y METODOS: Estudio observacional y retrospectivo sobre 74 pacientes intervenidos de EPU. Se ha recogido información acerca del sexo, realización de despistaje preoperatorio de RVU, los resultados (positivo o negativo para RVU) y grado de reflujo. RESULTADOS: 53 casos fueron masculinos (71,6%) y 21 (28,4%) femeninos. El despistaje de reflujo fue realizado en 55 pacientes (74,3%) frente a 18 (24,3%) en los que no se realizó ningún estudio. El 16,2% de los casos en los que se realizó el estudio preoperatorio de RVU fueron abordados mediante ecocistografía, siendo el estudio preoperatorio positivo en 6 pacientes del total de 73 estudiados (un paciente fue excluido por ser diagnosticado de válvulas de uretra posterior), lo que sitúa la prevalencia de RVU en pacientes ya diagnosticados de EPU en un 10,7%. De estos, un caso fue de grado I, dos grado II y un caso grado III, IV y V, respectivamente. CONCLUSIONES: El RVU en pacientes diagnosticados de estenosis de la unión pieloureteral presenta una incidencia ligeramente mayor que en la población general. El screening rutinario del reflujo vesicoureteral es innecesario, debiendo realizarse en casos que presenten infecciones urinarias previas, visualización del uréter dilatado en la ecografía o sospecha de causa secundaria.

Lobectomía por toracoscopia en pediatría. Nuestra experiencia y nuevas perspectivas de tratamiento / Thoracoscopic lobectomy in pediatrics. our experience and new treatment perspectives

Objetivos. Las malformaciones pulmonares en el niño son un espectro anatómico-clínico diferenciado. Tanto la malformación adenomatoide quística (MAC) como el secuestro pulmonar producen una amplia gama de síntomas, desde las formas asintomáticas hasta las más graves, y su manejo permanece controvertido. Asimismo, en los últimos años han aparecido trabajos que muestran la realización adecuada de esta cirugía mediante toracoscopia, siendo una alternativa a la cirugía tradicional. En este trabajo analizamos nuestra experiencia en la realización de lobectomías por toracoscopia, que demuestra ser una técnica segura y con menos complicaciones que por toracotomía. Métodos. Durante los años 2004-2008 se realizaron lobectomías en seis pacientes, con edades comprendidas entre 1 semana y 15 años. Los diagnósticos eran MAC en 4 casos, asociado a secuestro pulmonar (..) (AU)

Objectives. Pulmonary malformations in the child are a wide clinical and pathologycal spectrum. The congenital cystic adenomatoid malformation and the pulmonary sequestration both produce many symptoms, from the asymptomatic to the most complicated, and its management remains controversial. Moreover, in the last years many new publications show that this surgery can be perfectly accomplished with the thoracoscopic approach as an alternative to the tradicional open surgery. In this paper we analyse our experience in performing lobectomies with thoracoscopy. This technique shows to be safe and has less complications than tradicional thoracotomy. Methods. During the period 2004-2008 lobectomies were performed in six patiens, with ages between one week and fifteen years. The diagnostics where CAM in four cases, associated to PS in one case; broncogenic cyst in none case, and cavitary pulomonar aspergilloma in one (..) (AU)

[Thoracoscopic lobectomy in pediatrics. Our experience and new treatment perspectives]. / Lobectomía por toracoscopia en pediatría. Nuestra experiencia y nuevas perspectivas de tratamiento.

OBJECTIVES: Pulmonary malformations in the child are a wide clinical and pathologycal spectrum. The congenital cystic adenomatoid malformation and the pulmonary sequestration both produce many symptoms, from the asymptomatic to the most complicated, and its management remains controversial. Moreover, in the last years many new publications show that this surgery can be perfectly accomplished with the thoracoscopic approach as an alternative to the tradicional open surgery. In this paper we analyse our experience in performing lobectomies with thoracoscopy. This technique shows to be safe and has less complications than tradicional thoracotomy. METHODS: During the period 2004-2008 lobectomies were performed in six patiens, with ages between one week and fifteen years. The diagnostics where CAM in four cases, associated to PS in one case; broncogenic cyst in none case, and cavitary pulomonar aspergilloma in one case. RESULTS: Five inferior and one median lobectomies were done. In two cases the patients had no symptoms before intervention, the other four cases were asymptomatic. In all cases the toracoscopy was performed with 3 or 4 ports of 3-5 mm. No mini-thoracotomy was done in any case. There were nor intraoperatory neither postoperatory complications. In all patients were placed two thoracic drainages, being retired 3 to 4 days later. All patients, except one, remained five days in hospital. CONCLUSIONS: In this work, thoracoscopic lobectomy is confirmed as safe technique and with less complications and morbidity than the open lobectomy. Therefore, we suggest new posible aplications.