[New Modern Magpi: meatal advancement and glanuloplasty clinical course]. / New Modern Magpi: evolución del avance meatal con glanduloplastia.

INTRODUCTION: Meatal advancement and glanuloplasty (MAGPI) described by Duckett, has been the most accepted technique for distal hypospadias repair along the last 20 years. Only 50% of the distal variants are amenable to the Magpi; last years several modifications has been reported in order to reach better cosmetic results and to make it available for the most of the distal hypospadias. We report the first 20 cases with some modifications of Magpi. MATERIALS AND METHODS: The basic steps of the technique are: we remove a triangular segment of glanular tissue distal to the meatus. Dissection of the dorsal and lateral urethral sides is made, accomplishing the urethral advancement without any tension. Strips of glandular epithelium are excised on each side, and glans tissue is sutured above the ventral urethral wall. RESULTS: There were 11 coronal, and 9 glanular hypospadias (3 with megameatus). 8 cases showed a slight incurvation that disappeared after releasing any cutaneous chordee. The posoperative follow-up was 35 weeks (R=7-48 weeks). Cosmetic and functional results were excellent, showing a natural circumcized penis. There wasn't any complications as meatal retraction, stenosis or incurvation. There was only a transitional hematoma and a minimal fistula that closed expontanely. CONCLUSIONS: New Modern Magpi adds minimal variations to the original technique, avoiding the cosmetic limitations derived from borderline indications. New Modern Magpi is amenable to near all of glanular hypospadias and most of coronal hypospadias.

[Success of endoscopic management in vesicoureteral reflux, conditioned by ureteral dilatation]. / La dilatación ureteral condiciona el éxito del tratamiento endoscópico del R.V.U.

INTRODUCTION: Endoscopic management has become an important alternative in the treatment of vesicoureteral reflux in children. Since 1995 we indicate it in our Hospital in children with grade II VUR (vesicoureteral reflux) after 1 year of medical management, in all children with grade III VUR and in children with grade IV VUR without reflux nephropathy. According to International Classification of reflux (IRSC), grade IV VUR differ to grade III mainly by the blunting of the calyces and the obliteration of sharp angle of the fornices. There may be seen in the high grades of reflux, important differences in the ureteral dilatation. AIM: The aim of this work is to study the influence of ureteral dilatation in the success of endoscopic management VUR. MATERIAL AND METHODS: A number of 245 refluxing renal units (URR) were treated endoscopically in our Hospital from 1995. We review the first 3.5 years (58 patients with 90 RRU). In a double blind study with the voiding cystourethrographies we graduated the ureteral dilatation in slight-normal, moderate and severe. The success rate after the first injection was compared between the 3 grades of ureteral dilatation. RESULTS: 3 patients had grade I VUR, 10 grade II, 54 grade III and 23 grade IV. After double blind study 39 patients had slight-normal ureteral dilatation, 39 moderate and 12 severe. There were statistical differences between the 3 grades of ureteral dilatation when we consider: all the patients, considering only grade III and IV reflux and studying only the patients with grade III reflux. However there wasn't statistical differences between grade III and IV VUR of the International Classification. CONCLUSIONS: The results show that ureteral dilatation is an important prognostical factor of the success rate in the endoscopic management of vesicoureteral reflux in children.

La dilatación ureteral condiciona el éxito del tratamiento endoscópico del R. V. U / Success ofendoscopic management in vesicoureteral reflux, condicioned by ureteral dilatation

Introducción: El tratamiento endoscópico del reflujo vésico-ureteral (RVU) se ha convertido en una de sus principales armas terapéuticas. En 1995 se comienza a utilizar en nuestro hospital. Lo indicamos en los RVU de grado II no curados tras 1 año de tratamiento médico, en todos los de grado III y en los de grado IV sin daño renal. Según la Clasificación Internacional del Reflujo (IRSC); los reflujos de grado IV se diferencian de los de grado III básicamente por el abombamiento de los cálices. En cada uno de los grados de RVU se pueden observar distintos grados de dilatación ureteral. Objetivos: Estudiar la relación entre el grado de dilatación ureteral y la curación endoscópica del RVU independientemente de los gradosde reflujo. Material y métodos: De una serie de 245 unidades renales refluyentes (URR) intervenidas endoscópicamente; realizamos una revisión delos primeros 3,5 años (1996-1999). Se estudiaron 58 pacientes, con un total de 90 URR. Se valoraron las cistografías miccionales (CUMS).Mediante un estudio de doble ciego se graduó la dilatación ureteral de todos los pacientes en tres grados: leve-normal, moderada y severa. Se compararon los porcentajes de curación tras la 1ª inyección endoscópica en los tres grados de dilatación ureteral. Resultados: De las 90 URR estudiadas, 3 presentaban RVU de grado (..) (AU)