Corporoplastia ventral de cuerpos cavernosos para el tratamiento de la incurvación severa de pene en Urología Pediátrica / Ventral corpora cavernosa corporoplasty for the treatment of severe penile incurvation in Pediatric Urology

El Hipospadias es una patología congénita de los genitales masculinos que cada día diagnosticamos y tratamos más. Debido a un aumento de la casuística debemos tener a mano un arsenal de técnicas quirúrgicas para su correcto tratamiento. La Corporoplastia Ventral de cuerpos cavernosos es una de ellas que nos ayudara con éxito a tratar los caso más severos dentro de este espectro que es la patología en sí misma. Hablaremos de la técnica y sus indicaciones, además de nuestra experiencia en su utilización en 20 pacientes diferentes con excelentes resultados y sin complicaciones. La corporoplastia es una de las técnicas quirúrgicas con las que podremos tratar los casos más severos de incurvación peneana

Hypospadias is a congenital pathology of the male genitalia that we diagnose and treat more every day. Due to an increase of case load we must have at hand a large quantity of surgical techniques for its correct treatment. Ventral corporoplasty of the corpora cavernosa is one of them that will help us to successfully treat the most severe cases within this variety which is the pathology itself. We performed a prospective study in Malaga, Spain between 2010-2015. We review the technic and its indications, and the authors personal series with 20 cases performed by 2 surgeons using the same protocol and technics. The outcomes showed good results without complications in all cases. Corporoplasty is one of the surgical technique for the treatment of the most sever cases of penile incurvation

[Folic acid: Primary prevention of neural tube defects. Literature Review]. / Ácido fólico: prevención primaria de los defectos del tubo neural. Revisión bibliográfica.

Neural tube defects (NTD) are the most common congenital malformations of the nervous system, they have a multifactorial etiology, are caused by exposure to chemical, physical or biological toxic agents, factors deficiency, diabetes, obesity, hyperthermia, genetic alterations and unknown causes. Some of these factors are associated with malnutrition by interfering with the folic acid metabolic pathway, the vitamin responsible for neural tube closure. Its deficit produce anomalies that can cause abortions, stillbirths or newborn serious injuries that cause disability, impaired quality of life and require expensive treatments to try to alleviate in some way the alterations produced in the embryo. Folic acid deficiency is considered the ultimate cause of the production of neural tube defects, it is clear the reduction in the incidence of Espina Bifida after administration of folic acid before conception, this leads us to want to further study the action of folic acid and its application in the primary prevention of neural tube defects. More than 40 countries have made the fortification of flour with folate, achieving encouraging data of decrease in the prevalence of neural tube defects. This paper attempts to make a literature review, which clarify the current situation and future of the prevention of neural tube defects.

Ácido fólico: prevención primaria de los defectos del tubo neural. Revisión bibliográfica / Folic acid: Primary prevention of neural tube defects. Literature Review

Los defectos en el cierre del tubo neural (DTN) son las malformaciones congénitas más frecuentes del sistema nervioso, van a tener una etiología multifactorial, se producen por la exposición a agentes tóxicos químicos, físicos o biológicos, por factores carenciales, diabetes, obesidad, hipertermia, alteraciones genéticas y causas desconocidas. Algunos de los factores señalados se asocian con la desnutrición por interferir con la vía metabólica del ácido fólico (AF), vitamina encargada del cierre del tubo neural, y cuyo déficit produce las anomalías que pueden ocasionar abortos, mortinatos o lesiones graves del recién nacido que producen incapacidad, alteraciones en la calidad de vida y requieren tratamientos costosos para tratar de paliar en alguna forma las alteraciones producidas en el embrión. El déficit de ácido fólico se considera la causa última de la producción de defectos del tubo neural, la comprobación de la disminución de la incidencia de la Espina Bífida tras la administración preconcepcional de Ácido Fólico es evidente, lo que nos lleva a querer profundizar en el estudio de la acción del AF y su aplicación en la prevención primaria de los DTN. Más de 40 países han realizado la fortificación de harinas con folatos, llegando a conseguir datos esperanzadores de decrecimiento de la prevalencia de los DTN. Este trabajo intenta realizar una revisión bibliográfica que nos clarifique la situación actual y el futuro de la prevención de los DTN

Neural tube defects (NTD) are the most common congenital malformations of the nervous system, they have a multifactorial etiology, are caused by exposure to chemical, physical or biological toxic agents, factors deficiency, diabetes, obesity, hyperthermia, genetic alterations and unknown causes. Some of these factors are associated with malnutrition by interfering with the folic acid metabolic pathway, the vitamin responsible for neural tube closure. Its deficit produce anomalies that can cause abortions, stillbirths or newborn serious injuries that cause disability, impaired quality of life and require expensive treatments to try to alleviate in some way the alterations produced in the embryo. Folic acid deficiency is considered the ultimate cause of the production of neural tube defects, it is clear the reduction in the incidence of Espina Bifida after administration of folic acid before conception, this leads us to want to further study the action of folic acid and its application in the primary prevention of neural tube defects. More than 40 countries have made the fortification of flour with folate, achieving encouraging data of decrease in the prevalence of neural tube defects. This paper attempts to make a literature review, which clarify the current situation and future of the prevention of neural tube defects

Enuresis. Diagnóstico diferencial y tratamiento específico / Enuresis. Differential diagnosis and specific treatment

Introducción. A pesar de su gran prevalencia y antigüedad, esta patología tiene importantes interrogantes etiológicos, diagnósticos y terapéuticos. Hay que partir de dos grupos completamente diferentes: la enuresis (E) monosintomática o no complicada y el síndrome (S) enurético o E complicada con sus respectivos subgrupos, cada uno con etiología diferente que además es multifactorial. Diagnóstico diferencial. Se estructura en 3 niveles: 1º ¿E. monosintomática o S. enurético?; 2º ¿Patalogía o malos hábitos?; 3º ¿Disfunción de llenado o vaciado? Historia. Se describen tratamientos utilizados en diferentes culturas y épocas, demostrando la diversidad y a veces antagonismo que persiste hasta hoy, como demostración de la necesidad de un diagnóstico diferencial y un tratamiento etiológico. Tratamiento actual. Tras estudio de metaanálisis y revisiones sistemáticas se han ordenado por nivel de evidencia (NE) y grado de recomendación (GR) los estudios más válidos de tratamientos de E. monosintomática. La desmopresina, la alarma y la asociación de ambas tienen el máximo NE y GR, mientras que los antidepresivos tienen el mismo NE pero el menor GR por riesgo de efectos adversos. Los anticolinérgicos asociados a desmopresina están en el 2º nivel de NE y GR. Tratamiento personalizado. Se expone un tratamiento integral personalizado multidisciplinar. Se expone un tratamiento integral personalizado y multidisciplinar. Se inicia con diagnóstico diferencial y valoración psicológica. En E. monosintomática se inicia 1º un tratamiento básico conductal, seguido de un 2º paso con desmopresina y/o alarma según características personales. Si el resultado con uno de ellos es insuficiente se aconseja un 3º paso asociando el otro o añadiendo anticolinérgicos. Si es necesario un 4º paso se proponer biofeedback. El soporte psicológico de la familia y del niño es importante para la motivación, adhesión al tratamiento y mantenimiento de éxito. Conclusiones. Cada enurético es distinto y precisa un diagnóstico diferencial adecuado, además de una investigación personalizada, identificando sus factores influyentes. En la E. monosintomática el mejor NE y GR actualmente corresponden a la desmopresina, a la alarma y a ambas juntas. Hay que conocer todos los recursos terapéuticos disponibles, para diseñar un tratamiento lo más individualizado posible. Con frecuencia la combinación de tratamiento es efectiva. En la experiencia de los autores, el tratamiento multidisciplinar en equipo puede ser la mejor opción (AU)

Introduction. In spite of its great prevalence and antiquity, this condition has significant etiological, diagnostic and therapeutic questions. Two completely different groups must be considered: monosymptomatic or uncomplicated enuresis (E) and enuretic or complicated E syndrome (S) with their respective subgroups, each one with different etiology that is also multifactorial. Differential diagnosis. This diagnosis is structured into 3 levels: 1) Monosymptomatic E or enuretic syndrome?; 2) Disease or poor habits?; 3) Filling or emptying dysfunction? History. Treatments used in different cultures and periods that demonstrate the diversity and sometimes antagonisms that persists up to the current date are described as a demonstration of the need for a differential diagnosis and etiological treatment. Current treatment. After the meta-analysis study and systematic reviews, the most valid studies of treatments of monosymptomatic E. were ordered by level of evidence (LE) and recommendation grade (RG). Desmopressin, the alarm and the association of both have a maximum LE and while antidepressants have the same LE, but a lower RG, due to the risk of adverse events. The anticholinergics associated to desmopressin are on the second level of the LE and RG. Personalized treatment. A personalized comprehensive and multidisciplinary treatment is explained. It is begun with the differential diagnosis and psychological evaluation. In monosymptomatic E, a first basic behavioural treatment is initiated followed by a second step with desmopressin and/or o alarm according to personal characteristics. If the result with one of them is insufficient, a third step is recommended by means of associating the other or adding anticholinergics. If a four step is necessary, biofeedback is proposed. The psychological support of the family and of the child is important for motivation, treatment adherence, and maintenance of success. Conclusions. Each enuretic is differential diagnoses in addition to a personalized study, identifying their influencing factors. In Monosymptomatic E, the best LE and RG currently correspond to desmopressin, to the alarm and to both of them. It is necessary to know all the therapeutic resources available to design the most individualized treatment possible. The combination of treatments is frequently effective. In the experience of the authors, team multidisciplinary treatment may be the best option (AU)

Estenosis ppieloureteral de diagnóstico prenatal. Nuestro manejo / Pyeloureteral stenosis of prenatal diagnosis. Our management

La estenosis pieloureteral es la anomalía más frecuente del tracto urinario de diagnóstico prenatal. Actualmente la mayoría de los casos se diagnostican prenatalmente, pero algunos aún se hacen postnatalmente por el desarrollo de síntomas (dolor abdominal, infección urinaria, hematuria, tumoración abdominal o retraso en el desarrollo pondo-estatural). Dilatación no es sinónimo de obstrucción y se requieren estudios seriados con ultrasonidos (US) y renograma diurético (RD) para diferenciar la obstrucción de la dilatación sin patología. Los factores de riesgo de obstrucción se basan en los US y del RD y son: a)hidronefrosis de grado 3 o mayor, B) diámetro antero-posterior de la pelvis renal, medido en el plano transversal, mayor de 20 mm, c) tiempo medio de eliminación mayor de 20 minutos y d) función renal diferencial menor del 40% en el RD. El reflujo vesicoureteral existe en el 15% de los caos por lo que el cistograma suele ser necesario. La técnica operatoria de elección es la plastia desmembrada de Anderson-Hynes, que tiene buenos resultados es más del 95% de los casos. La endopielotomía se reserva para las reestenosis postoperatorias. La laparoscopia es la técnica ideal para niños mayores de una años (AU)

The Ureteropelic Junction Obstruction is the most frequent pathology of prenatal diagnosis.l Nowadays, most of the cases are done prenatally, but some of them have to be done after birth because of the symptoms developed/observed (abdominal pain, urinary tract infection, haematuria, abdominal pain, urinary tract infection, haematuria, abdominal mass or failure to thrive). Dilatation is not the same as obstruction, and serial studies with ultrasound (US) and diuretic renogram (DR) are required to make a differential diagnosis between obstruction and dilatation without pathology. The obstruction risk factors are based on US and DR, as follows: a) dilatation grade 3 or higher; b) anteroposterior renal pelvis diameter in transversal plane over 20mmm; c) average half time of elimination of radiotracer (T1/2) greater than 20 minutes; and d) differential renal function less than 40% in the DR. The vesicoureteral reflux is present in 15% of the cases so the voiding cystouretrogram is felt necessary. The gold standard surgical technique is the success. The endopyelothomy is the elective technique for postoperatory restenosis. Laparoscopic approach is ideal for children older than 12 months (AU)

Lavados colónicos anterógrados para el estreñimiento refractario en niños sin encefalopatía / Antegrade colonic enemas for intractable constipation in non-mentally retarded children

Revisión retrospectiva de las cecostomías realizadas para lavados anterógrados colónicos. Doce apendicocecostomías desde enero de 2002 a febrero de 2008, 9 apendicostomías en pacientes con mielomeningocele y 3 cecostomías en niños con estreñimiento crónico no orgánico sin encefalopatía ni retraso mental. De los 9 primeros pacientes, de entre 3 y 13 años, 8 tuvieron muy buena evolución y uno requirió retirada por mal empleo familiar. A un niño de 7 años, por lo demás sano, con estreñimiento crónico desde los 10 meses, pese a laxantes múltiples (varias tandas de desimpactación y dilatación anal bajo anestesia), con estudio morfofuncional normal, se le realizó, hace 5 años, cecostomía; persistió cierta tendencia a impactación pero con buena calidad de vida. Otro niño, previamente sano, de 12 años de edad, presentaba incontinencia fecal diaria asociada a estreñimiento desde los 3 años, con manometría anorrectal normal y biopsia con leve displasia neuronal; se le realizó cecostomía hace 3 años, con mejoría evidente y menor trastorno emocional secundario. El último caso de cecostomía tenía 8 años, con cuadro similar al anterior y se realizó procedimiento endoscópico con botón de Chait, con lo que mejoró francamente el cuadro. La progresión del estreñimiento rebelde a edad adulta tiene un impacto negativo en la adaptación social y el estado emocional del paciente, y puede alterar la vida familiar. Los lavados anterógrados colónicos proporcionan independencia y mejoran la calidad de vida. Se necesitan realizar en más pacientes para poder establecer verdaderos datos de efectividad (AU)

A descriptive review of 12 patients who underwent appendicocecostomy or caecostomy for antegrade colonic lavage from January 2002 to February 2008. There were 9 appendicocecostomies performed patients from 3 to 13 years suffering from myelomeningocele, of which 8 of them had a very good outcome, with one case with drawn due to poor use by the family. Three caecostomies were performed in non-mentally retarded constipated children. One was an otherwise healthy 7 year-old boy with hards tools since he was 10 months old, in spite of multiple laxative treatments, with normal morphology and function. He had a percutaneous caecostomy five years ago, with some improvement and a good quality of life, but still some occasional partial impactions. Another healthy 12 year-old boy with daily constipation associated faecal incontinence since he was 3 years old (normal manometry and rectal biopsy with signs of mild neuronal dysplasia)had a percutaneous caecostomy performed three years ago, with improvement in the faecal incontinence and better psychological out come. The last caecostomy patient was an 8 year-old boy, with a similar clinical history and good progress in last three years after placing a Chait’s button using an endoscopic procedure. Stubborn constipation continuing in to adult life has a negative impact on the social and emotional adaptation of the paediatric patient, affecting family interactions. Antegrade colonic lavage allows independence and improves the quality of life in patients affected by recurrent faecal impactions. This technique needs to be performed on more patients to find out its true effectiveness (AU)

[Antegrade colonic enemas for intractable constipation in non-mentally retarded children]. / Lavados colónicos anterógrados para el estreñimiento refractario en niños sin encefalopatía.

A descriptive review of 12 patients who underwent appendicocecostomy or caecostomy for antegrade colonic lavage from January 2002 to February 2008. There were 9 appendicocecostomies performed patients from 3 to 13 years suffering from myelomeningocele, of which 8 of them had a very good outcome, with one case withdrawn due to poor use by the family. Three caecostomies were performed in non-mentally retarded constipated children. One was an otherwise healthy 7 year-old boy with hard stools since he was 10 months old, in spite of multiple laxative treatments, with normal morphology and function. He had a percutaneous caecostomy five years ago, with some improvement and a good quality of life, but still some occasional partial impactions. Another healthy 12 year-old boy with daily constipation associated faecal incontinence since he was 3 years old (normal manometry and rectal biopsy with signs of mild neuronal dysplasia) had a percutaneous caecostomy performed three years ago, with improvement in the faecal incontinence and better psychological outcome. The last caecostomy patient was an 8-year-old boy, with a similar clinical history and good progress in last three years after placing a Chait's button using an endoscopic procedure. Stubborn constipation continuing into adult life has a negative impact on the social and emotional adaptation of the paediatric patient, affecting family interactions. Antegrade colonic lavage allows independence and improves the quality of life in patients affected by recurrent faecal impactions. This technique needs to be performed on more patients to find out its true effectiveness.

[Spontaneous urinary bladder perforation after pediatric cystoplasty]. / Perforación vesical espontánea tras cistoplastia en la infancia.

OBJECTIVE: The spontaneous cystoplasty perforation is a serious and potentially fatal problem if a delay in diagnosis and treatment occurs. We pretend: 1) to look for prevention analyzing the risk factors, 2) to identify the main data of diagnostic suspicion and 3) to evaluate the result of the treatments done. MATERIAL AND METHODS: Out of 30 children with cystoplasty 5 of them have presented 8 perforations (16,6%). Several influential factors, the symptoms, the treatments and the evolution are reviewed. RESULTS: The average time between cystoplasty and the perforation was 8,2 years. A urethral resistance that allows continence, and an insufficient intermittent catheterization, have been the main risk factors. In the 8 episodes there were abdominal pain and distension. The ultrasonography showed intraperitoneal extravasation in 5 episodes, multiple peritoneal cysts in one, and suggestive image of appendicular plastron in another one. The cystography showed intraperitoneal extravasation only in 3 cases. The initial management was conservative in the 7 episodes diagnosed before surgery, and 3 had a good evolution (42,8%); the other 4 needed surgery with good evolution in all cases. Two of 5 patients (40%) presented 3 relapses in an average time of 5 years. The survival is 100%. CONCLUSIONS: 16,6% of patients with cystoplasty of this series had one or more episodes of spontaneous bladder perforation. The more significant risk factors are a high urethral resistance and an inadequate intermittent catheterization. The patients with cystoplasty, and their families, must know this complication, their risk factors and symptoms to prevent it, or to facilitate an early diagnosis.

Perforación vesical espontánea tras cistoplastia en la infancia / Spontaneous urinary bladder perforation after pediatric cystoplasty

Objetivos: La perforación espontánea de una cistoplastia es un problema grave y potencialmente fatal, si no se diagnostica y se trata a tiempo. Se pretende: 1) buscar una prevención analizando los factores de riesgo, 2) identificarlos principales datos de sospecha diagnóstica y 3) valorar el resultado de los tratamientos realizados. Material y Método: De 30 pacientes pediátricos con cistoplastia, 5 presentaron 8 perforaciones (16,6%). Se revisan los diversos factores influyentes, la clínica, los tratamientos y la evolución. Resultados: El tiempo medio transcurrido entre la cistoplastia y la perforación fue 8,2 años. Los principales factores de riesgo han sido una resistencia uretral que permitía continencia, y una insuficiente realización temporal del sondaje intermitente (SI). En los 8 episodios hubo dolor y distensión abdominal. La ecografía mostró líquido libre intraperitoneal en 5, múltiples quistes peritoneales en 1, e imagen sugestiva de plastrón apendicular en otro. La cistografía sólo mostró paso de contraste a la cavidad peritoneal en 3. El tratamiento inicial fue conservador, sin cirugía, en los 7 episodios diagnosticados preoperatoriamente, siendo la evolución favorable en 3(42,8%); los otros 4 necesitaron tratamiento quirúrgico, con buena evolución en todos. De los 5 pacientes, 2 (40%) presentaron 3 recidivas en un tiempo medio de 5 años. La supervivencia es del 100 %.Conclusiones: El 16,6% de los pacientes con cistoplastia de esta serie, ha tenido uno o más episodios de perforación vesical espontánea. Los factores de riesgo más significativos son una resistencia uretral alta y la inadecuada realización del SI. Los pacientes con cistoplastia y sus familias deben conocer esta complicación, sus factores de riesgo y sus síntomas, para prevenirla o facilitar un diagnóstico precoz (AU)

Objective: The spontaneous cystoplasty perforation is a serious and potentially fatal problem if a delay in diagnosis and treatment occurs. We pretend: 1) to look for prevention analyzing the risk factors, 2) to identify the main data of diagnostic suspicion and 3) to evaluate the result of the treatments done. Material and Methods: Out of 30 children with cystoplasty 5 of them have presented 8 perforations (16,6%). Several influential factors, the symptoms, the treatments and the evolution are reviewed. Results: The average time between cystoplasty and the perforation was 8,2 years. A urethral resistance that allows continence, and an insufficient intermittent catheterization, have been the main risk factors. In the 8 episodes there were abdominal pain and distension. The ultrasonography showed intraperitoneal extravasation in 5 episodes, multiple peritoneal cysts in one, and suggestive image of appendicular plastron in another one. The cystography showed intraperitoneal extravasation only in 3 cases. The initial management was conservative in the 7 episodes diagnosed before surgery, and 3 had a good evolution (42,8%); the other 4 needed surgery with good evolution in all cases. Two of 5 patients (40%) presented 3 relapses in an average time of 5 years. The survival is 100%. Conclusions: 16,6% of patients with cystoplasty of this series had one or more episodes of spontaneous bladder perforation. The more significant risk factors are a high urethral resistance and an inadequate intermittent catheterization. The patients with cystoplasty, and their families, must know this complication, their risk factors and symptoms to prevent it, or to facilitate an early diagnosis (AU)

Guía para el diagnóstico y tratamiento de la enuresis nocturna monosintomática en Atención Primaria / Guide for the diagnosis and treatment of monosymptomatic nighttime enuresis in Primary Health Care

La enuresis nocturna monosintomática es una entidad nosológica benigna, muy frecuente en la infancia, que puede favorecer la aparición de importantes problemas psicológicos y de autoestima a medida que se va incrementando la edad de los niños que no corrigen su problema. En la presente Guía se repasan los criterios diagnósticos, los exámenes complementarios que se recomiendan inicialmente y los tratamientos disponibles en la actualidad. Al tratarse de un proceso benigno, el tratamiento de la enuresis debe realizarse con medios terapéuticos eficaces y con una baja tasa de efectos secundarios potenciales. Se recomienda iniciar el tratamiento con desmopresina o con alarmas sonoras. La ausencia de eficacia de uno de los dos remedios o de ambos debe ser criterio de remisión de los jóvenes pacientes a un centro especializado (AU)

The Monosyptomatic nocturnal enuresis is a benign entity very frequent in childhood that can trigger the appearance of important psychological problems and of selfesteem, especially, when the children do not correct this problem grow older. In the present paper we review the diagnostic criteria, the complementary exams initially recommended and the current available treatments. Being a benign process, the nocturnal enuresis treatment should be carried out with effective therapeutic means and with a low rate of potentials secondary effects. The treatment should begin with desmopressin or with sound alarms. The lack of effectiveness of either or both remedies should be a criterion for remission of the patient to a specialized Center (AU)

Presente y futuro de la urología pediátrica / Present and future of pediatric urology

No disponible

Autoembolización espontánea en un niño con priapismo postraumático de alto flujo / Spontaneous self-embolization in a child with postraumatic high flow priapism

Existen dos tipos de priapismo: el venoso o de bajo flujo, que es característicamente doloroso, y el arterial o de alto flujo, indoloro y mucho más raro, especialmente en la infancia. Se expone el caso de un varón de 5 años que 6 días después de sufrir un traumatismo perineal cerrado, presentó un priapismo indoloro, de tipo arterial, con aneurisma y fístula de la arteria dorsal del pene, que se resolvió espontáneamente mediante autoembolización, 11 días después de su inicio. Se hace una revisión bibliográfica de 14 casos de priapismo arterial postraumático en la infancia, no habiendo encontrado ningún otro caso resuelto mediante autoembolización espontánea (AU)

[Spontaneous autoembolization in a child with high-flow post-traumatic priapism]. / Autoembolización espontánea en un niño con priapismo postraumático de alto flujo.

There are two sort of priapism: the venous or low flow priapism, that is usually painful, and the arterial or high flow one, painless and rare, especially in childhood. We present a case of a boy 5 years old, who 6 days after to suffer a perineal closed traumatism, had a painless and arterial priapism, with aneurism and fistula of the dorsal penile arteria, that was resolute spontaneously through self-embolization, 11 days after. We review the bibliography of 14 cases of arterial posttraumatic priapism in childhood, without find any case resolute by spontaneous self-embolization.

[Long-term follow-up of children with neurogenic bladder and artificial urinary sphincter]. / Resultado a largo plazo del esfínter urinario artificial en niños con vejiga neurógena. A propósito de 16 casos en 12 años.

MATERIALS AND METHODS: Since 1986 an artificial urinary sphincter was implanted in 16 children (13 males and 3 females) 4 to 12 years old (median age 9) in order to solve their urinary incontinence. Mean age at implantation was 9 years. In 10 children (63%) only the implant procedure of artificial sphincter was performed without any other procedure associated (Group A), while in 6 children an augmentation cystoplasty simultaneously was performed (Group B). The results were analysed in both groups separately: 1. Group A: 10 patients. Two are functioning excellently after 10 and 11 years of follow up. Eight developed some type of troublesome: Five developed a deterioration of urinary tract and all of five were treated by augmentation cystoplasty; one of them is in a good condition after 11 years, another presented a fail of the device after 10 years, it has been changed, and in the others three the apparatus was removed by diverse causes. Two developed a mechanical fail of device: one was removed due familiar decision and the other has received another device. One urinary fistula developed 6 months later. The device was removed. 2. Group B: 6 patients (artificial sphincter and augmentation cystoplasty simultaneously). Five are functioning without trouble some. One persistent urinary fistula. The device was removed. Actually, of 16 cases (both groups) 8 cases (50%) are good functioning, 6 devices have been removed and 2 are waiting a new implant. CONCLUSIONS: The artificial urinary sphincter is a good solution for children with urinary incontinence in selected cases, but is mandatory a correct follow up because longterm complications can be developed. Results seem better when an augmentation cystoplasty is associated.

[Intermittent catheterization as the basis for treatment of neurogenic bladder during childhood]. / El sondaje intermitente como base del tratamiento de la vejiga neurógena durante la infancia.

OBJECTIVE: Neurogenic bladder (NB) frequently causes incomplete bladder emptying, which can lead to deterioration of the upper urinary tract (UUT), vesico-renal reflux (VRR) and incontinence. The aim of this study is to determine the degree of acceptance, performance and results of treatment of NB in children by intermittent catheterization (IC). METHODS: Of 121 children (50 girls and 38 boys) with NB, 88 were managed by intermittent catheterization. The mean age at treatment was 5.2 years (range 20 days-13 years). PVC catheters were employed and reutilized for 3 or 4 weeks. Catheters were aseptic but not sterile. Antimicrobial prophylactic therapy was not administered except in patients with VRR. The statistical study was descriptive and results were compared using the Pearson chi square test. RESULTS: 90% had 4 or more catheterizations daily. Family and patient cooperation was good in 90% of the cases. Patients were managed by IC for a mean period of 4 years (range 1 month-14 years). Only two cases (2%) showed mild, transient complications (urethral pain and cystitis). Normal UUT remained normal in 85%; 45% with compromised UUT improved and 7% became worse. Of the children with no VRR, 94% did not develop this complication; VRR resolved in 72% of the cases (24% by IC alone and 48% with drugs or surgery). Only 12% were continent for more than 3 hours, which increased to 77% (64% by IC alone and 86% with drug therapy or surgery). Urethral sphincter urodynamics was the most important prognostic factor: patients with a lower urethral resistance showed better results for the UUT (p = 0.00373) and VRR (p = 0.00943). The results were also better in patients with normal UUT (p = 0.0003) and no VRR (p = 0.009). CONCLUSIONS: IC is not limited by patient age, sex or sociocultural level. It preserves normal TUS and prevents VRR when instituted early, on demonstrating residual urine and high urethral resistance. IC alone or in combination with other treatments is the basic therapy in NB.

[Fluid loss pressure in 45 children with congenital neurogenic bladder]. / Presión de pérdida de líquido en 45 niños con vejiga neurógena congénita.

OBJECTIVE: This study analyzed the relation between leak point pressure (LPP) at first urodynamic evaluation and the status of the upper urinary tract (UUT) and renal reflux (RR). METHODS: The study comprised 45 myelodysplastic children, one week to 13 years of age; 19 (42%) were less than one year old. LPP was measured when liquid started to come out through the urethral meatus, around the 5-6 Fr catheter. UUT was evaluated by ultrasound and RR by voiding cystography. RESULTS: 19 children had LPP < 30 cm H2O; all cases had a normal UUT, although 5 (26%) had RR. Twenty-six cases (58%) had LPP > 30 cm H2O; 12 (46%) had abnormal UUT and 6 of these had RR; 7 cases had RR but normal UUT. The group with LPP > or = 30 cm H2O was analyzed according to LPP values. The UUT was abnormal in 31% of cases with LPP 30-60 cm H2O and 37% had RR; UUT was abnormal in 70% of cases with LPP > 60 cm H2O and 70% had RR. Of the 19 patients less than one year old 9 (47%) had LPP < 30 cm H2O, no patient had abnormal UUT and only two (22%) had RR; 10 cases had LPP > or = 30 cm H2O, 6 of these had abnormal UUT and 5 had RR. CONCLUSIONS: In this study UUT was normal when LPP was < 30 cm H2O. Renal impairment and RR increased with LPP. Urethral functional obstruction carries a worse prognosis of pediatric neurogenic bladder. In these cases clean intermittent catheterization is recommended, regardless of patient age and sex.

[The treatment of the primary intrarenal reflux. Is the surgery always necessary?]. / Tratamiento del reflujo intrarrenal primario. Es imprescindible la cirugía?

UNLABELLED: THE AIMS OF THIS STUDY was to evaluate the relationship between intrarenal reflux (I.R.R.) and reflux nephropathy (R.N.) in order to know the results of surgical and non surgical treatment. Fifty one children with 64 kidneys with primary I.R.R. were studied. 53% of them were less than one year of age. Initial examination were: urography, ultrasounds, cystography and DMSA scan; the follow up was done with ultrasounds, DMSA scan and cystography. When no R.N. was present, grade of reflux was < IV, and age < 12 years, a non surgical treatment was indicated. RESULTS: During first examination R.N. was demonstrated in 47% of kidneys; the main difference was the grade of reflux: 16/44 II-III (36%) and 14/20 IV-V (70%). Surgical treatment was performed in 42 (82%) children and non surgical in 9 (18%). Reflux stopped in 98% and 100%, respectively. Only one child, without R.N., developed a new renal scar, and a previous R.N. progressed in two. I.R.R. can be treated successfully without surgery in selected cases.

[Laparoscopy in the non-palpable testicles. Is it always necessary?]. / Laparoscopia en testículos no palpables. Es siempre necesaria?

In order to know the role of diagnostic laparoscopy with non palpable testicles (NPT), 15 children with 16 NPT were studied. Middle age was 7 years (R: 2-12). The surgical procedure was: laparoscopy initially and open inguinal surgery (OIS) after that. Six NPT were discovered with laparoscopy (37.5%). With OIS inguinal hernia was present in 4 cases, with testicle into the inguinal sac in 3 cases; 12 cases had not inguinal hernia, and 6 of them showed spermatic vessel and vas deferent without testicle. Orquidopexy of the 6 located testicles and testicular prothesis implantation in the other 10 cases, were performed. Finding of laparoscopy and OIS were perfectly correlated. Laparoscopy made the diagnosis in 7 cases, which the OIS would have been unable to do it (43.7%). In the other 9 cases, the OIS would have been diagnostic enough (56.2%) without laparoscopy. For those results, the authors prefer to begin the surgical procedure with OIS and if the spermatic vessels are no located, then the laparoscopy is done under the same anesthesia.

[Postnatal differential diagnosis of fetal ureteropelvic dilatation]. / Diagnóstico diferencial postnatal de la dilatación pielocalicial fetal.

UNLABELLED: A clinical study of 51 children with prenatal diagnosis of pielocaliceal dilatation with 65 kidney affected is done. The objective was to assess the accuracy of the postnatal diagnostic studies practiced in order to an early differentiation between obstructive and non obstructive dilatation. MATERIAL AND METHODS: There were evaluated ultrasonography (US), intravenous pielography and diuretic isotopic renogram. The data were statistically analyzed with SPSS program. A regression logistic analysis was carried out between all the significant variables in order to identify the obstruction risk factors. Also the probabilities calculated index and the sensibility and specificity were studied. RESULTS: The obstruction risk factors were: grade III dilatation or greater in the US, differential renal function less of 40%, and half time more than 21 minutes. The probabilities calculated index showed that the probabilties of obstruction are different according to the number of obstruction risk factors presented in every patient. Risk factors have a high sensibility and specificity as diagnostic test.