Robotic-assisted kidney transplantation: our first case.

PURPOSE: Kidney transplantation is the preferred treatment for patients with end-stage renal disease. In order to reduce the morbidity of the open surgery, a robotic-assisted approach has been recently introduced. According to the published literature, the robotic surgery allows the performance of kidney transplantation under optimal operative conditions while maintaining the safety and the functional results of the open approach. METHODS: We present the case of a mother donating to her daughter affected by end-stage renal disease (ESRD) due to Alport disease (creatinine: 353 umol/l; GFR: 13 ml/min per 1.73 m(2)). RESULTS: A robotic-assisted kidney transplant (RAKT) was successfully performed. Surgical time was 120 min with 53 min for vascular suture. The estimated blood loss was <50 cc. The kidney started to produce urine intra-operatively with a rate of 250 cc/h, which remained constant over the next hours. During the first postoperative day, the patient was ambulating and started oral intake. Pain was minimal, and no analgesia was required after 48 h. Serum creatinine improved progressively to 89 umol/l on postoperative day 3. No surgical complications were recorded, and the patient was sent home on postoperative day 5. CONCLUSION: We present the first Spanish transperitoneal pure RAKT from a living-related donor. We believe this is the second pure robotic-assisted kidney transplantation case performed in Europe. We believe that the potential advantages of RAKT are related to the quality of the vascular anastomosis, the possible lower complication rate and the shorter recovery of the recipients.

Can endoscopic balloon dilation for primary obstructive megaureter be effective in a long-term follow-up?

BACKGROUND: Ureteral tapering and reimplantation is an established treatment for persistent or progressive primary obstructive megaureter (POM) but may result in complications and morbidity. Use of a less invasive technique involving endoscopic balloon dilation appears very interesting. OBJECTIVE: The objective of this report is to determine if endoscopic balloon dilation for POM is effective in the long term as well as to assess complications of the procedure. MATERIAL AND METHODS: A retrospective review was done on 19 patients and 20 ureters treated with the endoscopic balloon dilation by POM from June 2000 to February 2010. Surgery was performed solely in those cases in which there was persistence of obstruction in the renogram along with one or all of the following conditions: impairment of the differential renal function <40%, worsening of the renal pelvic dilation, febrile UTI in spite of antibiotic prophylaxis or renal calculi. The patients comprised 16 boys and 3 girls with a mean age at surgery of 17 months (range 1-44 months). Ten cases were left sided, eight right sided, and one bilateral. Under endoscopic and fluoroscopic guidance, a 3-5 Fr dilating balloon was inflated to 12-14 atm, or until disappearance of the stenotic obstructive area. A double J stent was positioned and withdrawn 2 months later. Follow-up recorded the presence of symptoms, number of reintervention procedures registered, and included renal ultrasound and MAG-3 renogram. RESULTS: There were no perioperative complications. Eighteen ureters showed a non-obstructive pattern on MAG-3 renogram after the first endoscopic dilation, representing a 90% success rate. One case required a second dilation, which proved successful and two cases of recurrent lithiasis required ureterotomy without instances of obstruction. 2 patients had a febrile UTI and a vesicoureteral reflux was diagnosed in one. Renal function was preserved in 95% of patients. The mean follow-up was 6.9 years (range 3.9-13.3 years). One patient was lost after the procedure. DISCUSSION: In an era of minimally invasive techniques, the search for less invasive procedures for treatment of POM has resulted in a variety of surgical options. Angulo et al., in 1998 and our group described the first POM treatment with endoscopic balloon dilation, which is believed to be a definitive, less invasive, and safe treatment. Furthermore, should an endoscopic approach fail, reimplant surgery can be performed. Few publications have reported short series with good results in the short and medium term. Torino et al. presented five cases in children aged less than 1 year, none of these showed evidence of obstruction. García-Aparicio et al. presented a series of 13 patients treated with a success rate of 84.6%. Christman et al. added laser incision in cases of narrowed ureteral segment 2-3 cm long and used double stenting. Good outcomes were presented in 71%. Romero et al. reported improvement of drainage within the first 18 months after treatment in 69% of patients. The potential de novo onset of vesicoureteral reflux may be the source of some controversy. We consider that dilation does not significantly alter the antireflux mechanism. In VCUG is not systematically performed because it is an invasive test. This restricts the conclusions that can be drawn from our findings. Nevertheless, some groups continue to systematically perform VCUG. CONCLUSIONS: Endoscopic balloon dilation for POM is a safe, feasible, and less invasive procedure that shows good outcomes on long-term follow-up. However, multicenter studies and prospective trials should be encouraged to provide more definitive evidence on its benefits.

Incidencia, diagnóstico y tratamiento del cáncer urológico en el paciente trasplantado renal. Revisión de la bibliografía / Incidence, diagnosis and treatment of urological cancer in patients with kidney transplantation. Literature review

La inmunosupresión a la cual se someten los pacientes trasplantados renales se ha relacionado a un incremento en la incidencia de las enfermedades neoplásicas, así como un comportamiento distinto de estas con respecto al presentado en la población general. Se realizó una revisión sistemática de la literatura en PubMed, de los artículos referidos a «tumores urológicos en pacientes trasplantados renales». Las neoplasias urológicas, representan un 15% de los tumores en el TR, además de ser en algunas series la principal causa de muerte de origen neoplásico. Dicha población tiene 15 veces más probabilidades de presentar cáncer de células renales (CaCR), 3 veces de cáncer de células transicionales de vejiga (CaCTV), 3 veces de cáncer testicular, y 2 de cáncer de próstata (CaP). Los tratamientos son similares a la población no trasplantada; en caso del CCR predomina la indicación de nefrectomía radical en el riñón nativo, y cirugía conservadora en el injerto. En el CaP localizado, la prostatectomía radical es técnicamente factible. En el CaCTV la inmunosupresión no representa una contraindicación para la administración de BCG o MMC. Los tumores urológicos se pueden abordar de la misma manera que la población general, por lo que debido al potencial peor pronóstico en relación a la inmunosupresión se requiere, en esta población específica, un seguimiento más estrecho (AU)

The immunosuppression to which the kidney transplant patients are subject, has been linked to an increase in the incidence of neoplastic diseases, as to a difference in behaviorof this diseases with respect to the general population. A systematic review of the literature in PubMed focused on the articles with the topic " urological tumors in renal transplant recipients" was conducted. The urological neoplasms represent 15 % of all tumors in renal transplant recipients. In some series they are the main cause of death. This population has increased incidence rate of renal cell carcinoma (15-fold), bladder (three-fold), testicular (three-fold), and prostate cancer (two-fold). The treatment they receive are similar to that of the general population; RCC has to be treated with radical native nephrectomy in case of tumor, and conservative surgery in case of tumor in the graft. In patients with localized prostate cancer, radical prostatectomy is technically feasible. Regarding transitional cell carcinoma, immunosuppression is not a contraindication for the administration of BCG or MMC. These tumors can be managed following the same criteria as in the general population. Due to the potentially poor outcome because of the immunosuppression, closer monitoring is required in this specific population (AU)

Espina bífida y vejiga neurógena. Manejo de un caso complejo con esfínter artificial, ampliación vesical y derivación urinaria / Spina bifida and neurogenic bladder. Managing a complex case with artificial sphincter, bladder augmentation and urinary diversion

Se presenta caso de varón de 26 años con antecedente de espina bífida y mielomeningocele. Diagnosticado de vejiga neurógena con sistema de bajas presiones inicialmente debido a incontinencia de orina fue tratado con esfínter artificial. Después de la operación presentó un patrón de sistema de altas presiones que requirió ampliación vesical, derivación tipo Mitrofanoff y retirada del esfínter. Con ello se consiguió que la presión del detrusor se mantenga dentro de límites seguros durante las fases de llenado y vaciado para proteger la función renal. Es de gran importancia el diagnóstico y seguimiento urológico temprano de los niños y niñas con esta enfermedad mediante los estudios urodinámicos para determinar el patrón vesical y esfinteriano y decidir la mejor estrategia de tratamiento posible. La finalidad fundamental es convertir la vejiga en un sistema de baja presión, conseguir la continencia y preservar la función renal (AU)

Twenty-six years old male with a history of spina bifida and myelomeningocele is presented. Neurogenic bladder with initially low pressure system due to urinary incontinence was treated with artificial sphincter. After the operation presented a pattern of high pressure system that required bladder augmentation, Mitrofanoff diversion and removal of the sphincter. Through these measures safe limits during the phases of filling and emptying of the bladder were achieved, to protect renal function. It is very important the early diagnosis and monitoring of urological children with spina bifida with urodynamic study to determine bladder and sphincter patterns and determine the best possible treatment strategy. The main purpose is to convert the bladder in a low-pressure system, achieve continence and preserve renal function (AU)

Tratamiento del cáncer de próstata y cáncer renal con fármacos orales (abiraterona y antiangiogénicos): posicionamiento de la Asociación Española de Urología / Treatment of prostate and renal cancer with oral drugs (abiratarone and antiangiogenic agents): Positioning statement from the Spanish Association of Urology

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Esquistosomiasis vesical y en la población pediátrica. Reporte de un caso y revisión de la literatura / Bladder schistosomiasis in the pediatric population. Case report and literatur review

La esquistosomiasis es una enfermedad que afecta a más de 200 millones de personas a nivel mundial. Es poco frecuente en nuestro medio, estando sobre todo distribuida a lo largo de África, en algunas áreas del Oriente Medio, en el oeste de Asia y ciertas zonas de América Latina. Se estima que 88 millones de los infectados son menores de 15 años. La hematuria es el síntoma cardinal, y se debe sospechar en los pacientes provenientes de las áreas de riesgo (sobre todo África subsahariana). Presentamos el caso de un niño de 11 años, originario de Mali, que consultó por presentar durante un año macrohematuria monosintomática; se siguió nuestro método diagnóstico, evidenciando la enfermedad causante del proceso, estableciéndose tras ello la terapéutica pertinente. Se realiza a partir de ahí una revisión de la literatura de la patología que nos ocupa (AU)

Schistosomiasis is a prevalent disease affecting more than 200 million people world wide. Even though is an infrequent disease in our environment, it is endemic trough Africa, some Middle East areas, Western Asia and certain South American areas. There are approximately 88 million children, 15 years old or less, affected. Hematuria is the paramount symptom, and we should suspect this infection in patients who come from this risky area. We report an 11 year old boy, originally from Mali, who complaint about having approximately a year of gross hematuria, discussing the pertinent assessment and treatment. Performing a literature review of the causative pathology (AU)

¿Es posible una vejiga artificial? Progresos en las últimas décadas / Is it possible an artificial bladder? Progress in the last decades

El carcinoma de células transicionales de vejiga (CCTV) es el tumor maligno más frecuente del tracto urinario, y su incidencia va en aumento. Dependiendo del estadio del tumor, los tratamientos pueden variar de más conservador a otros como la cirugía radical. En el CCTV invasor de la vejiga el tratamiento estándar es la cistectomía radical con linfadenectomía extendida y la configuración de una bolsa continente o no continente (conducto/neo-vejiga). La reconstrucción de la neovejiga se logra usando segmentos de intestino destubulizados. Por desgracia, la cirugía intestinal presenta la posibilidad de complicaciones postoperatorias como fístulas, infecciones, trastornos metabólicos. Desde la década de 1960 los urólogos y los científicos, así como la industria biotecnológica han tratado de evitar el uso de intestino, recurriendo al uso de materiales sintéticos o biológicos alternativos para reconstruir la vejiga. Pero pese a los avances tecnológicos y de conocimiento biomédico, los resultados han sido bastante desalentadores hasta la actualidad. En esta publicación realizamos una revisión exhaustiva de los modelos aloplásticos en la construcción de neo-vejigas, y se realiza un análisis crítico sobre los pros y los contras de las diversas iniciativas que han existido sobre esta opción; y se exponen algunas reflexiones sobre como habrá de ser la prótesis sintética ideal de vejiga (AU)

Transitional cell carcinoma (TCC) of the bladder is the most frequent malignancy of the urinary tract, and its incidence is rising. Depending on the stage of the tumor, the treatments for TCC of the bladder may vary from a conservative to a radical surgery. In case of invasive TCC of the bladder the gold standard treatment is represented by radical cystectomy with extended lymphadenectomy and configuration of a continent or non-continent pouch (conduit/ pouch/neo-bladder). The reconstructive step of radical cystectomy is achieved with the use of bowel segments to restore bladder function. Unfortunately, the need for bowel has been universally considered to be the prime source of postoperative complications (i.e. fistulas, infections, metabolic disorders). Since the 1960s urologists, scientists and the industry have been trying to obviate the use of bowel with alternative synthetic and biologic materials to reconstruct the bladder. Despite the progress in technology and knowledge, the results have been quite discouraging. In this study we provide a comprehensive review for alloplastic models for neo-bladders with a critical analysis on the related pros and cons of restoring urinary bladder function with an ideal synthetic prosthesis (AU)

Tumores testiculares en la infancia / Testicular Tumours in Infancy and children

Introducción: los tumores testiculares prepuberales son distintos a los que se presentan en la edad adulta. Tradicionalmente han sido considerados malignos, pero realmente los tumores testiculares benignos son más frecuentes en esta edad. Material y métodos: revisamos nuestra experiencia en el tratamiento de los tumores testiculares en niños ≤ 13 años con intención de evaluar el empleo de orquiectomía parcial. Desde 1984 hasta 2008 hemos diagnosticado y tratado en nuestro centro 15 tumores testiculares en edad pediátrica. Se revisa la actitud terapéutica empleada con énfasis en la posibilidad de preservación testicular en pacientes seleccionados y se evalúan los resultados. Resultados: la forma de presentación clínica en el 80% de los casos fue aumento del tamaño testicular con masa palpable. Se realizaron 4 orquiectomías radicales (27%) y 11 tumorectomías (73%). Todas las lesiones benignas en la anatomía patológica definitiva fueron tratadas con tumorectomía: cuatro quistes epidermoides, un hemangioma, un lipoma, un hamartoma fibroso, un tumor de la granulosa juvenil y una fusión espleno-gonadal. También fueron tratados con éxito de forma conservadora dos casos de teratoma. Los casos tratados de manera radical fueron un caso de tumor de saco vitelino (estadio I), dos tumores germinales mixtos y un gonadoblastoma. Conclusiones: los tumores testiculares en la edad prepuberal benignos predominan sobre los malignos. Ante una masa testicular palpable con marcadores tumorales negativos se puede plantear un tratamiento conservador mediante tumorectomía. No obstante, la lesión debe ser completamente extirpada para evitar recurrencias (AU)

Introduction: prepubertal testicular tumours are different from those that appear during adulthood. Traditionally, they were considered to be malignant, however benign testicular tumours are actually more frequent at this age. Materials and methods: we analysed our experience in the treatment of testicular tumours in children ≤ 13, with the intention of evaluating the use of partial orchiectomy. From 1984 to 2008, we diagnosed and treated 15 testicular tumours in children at our centre. We examined the therapeutic approach employed, underlining the possibility of testicular conservation in selected patients and we have analysed the results. Results: the clinical presentation in 80% of the cases was an increase in testicle size with palpable mass. We performed 4 radical orchiectomies (27%) and 11 tumourectomies (73%). All the benign lesions in the final pathological anatomy were treated with tumourectomy: four epidermoid cysts, one hemangioma, one lipoma, one fibrous hamartoma, one juvenile granulosa tumour and one splenogonadal fusion. We also successfully and conservatively treated two cases of teratoma. The cases that received radical treatment were a yolk sac tumour (Stage I), two mixed germ cell tumours and one gonadoblastoma. Conclusions: there are more cases of benign testicular tumours than malignant tumours during puberty. In the event of a palpable testicular mass with negative tumour markers, conservative treatment by means of a tumourectomy may be considered. However, the lesion must be removed completely to prevent recurrence (AU)

[Renal retransplantation: risk factors and results]. / Retrasplante renal: factores de riesgo y resultados.

OBJECTIVE: to review our experience in renal retransplantations. MATERIALS AND METHODS: we carried out a retrospective study on 71 patients with retransplantation performed between 1980 and 2005. We studied: the characteristics of the recipient and graft, surgery data, causes of loss of the graft, number of rejects and transplantectomies and, survival of the graft. RESULTS: the most frequent cause of graft loss was chronic rejection. The causes of first graft loss were not associated with a greater loss of the second graft (p>0.05). The percentage of anti-HLA antibodies increased in the second transplant in comparison to the first (17.23±27.91% vs. 1.21±7.43%) (p=0.001), however, it was not correlated with a significant increase in loss of the second graft (p=0.320). There were no significant differences between the complications of the first and second transplants (p>0.05) and they were not associated with graft loss (p>0.05). The patients with a transplantectomy in the first transplant presented a risk 8.5 times higher of undergoing a second one (p=0.0001; OR: 8.54; CI: 95% 0.941 - 77.501). The most frequent cause of transplantectomies in the second transplant was acute rejection. Acute rejection as a cause for transplantectomy in the first transplant proved to be an independent risk factor of transplantectomy of the second transplant (p=0.009). The mean survival of the second graft was 5.08±4.81 years, higher than the first transplant (p=0.133). The survival of the graft at 1.5 and 10 years was 83%, 75% and 52%, respectively. CONCLUSIONS: the survival of the second transplant was not lower than the first, neither was there an increase in the number of complications.

[Testicular tumours in infancy and children]. / Tumores testiculares en la infancia.

INTRODUCTION: prepubertal testicular tumours are different from those that appear during adulthood. Traditionally, they were considered to be malignant, however benign testicular tumours are actually more frequent at this age. MATERIALS AND METHODS: we analysed our experience in the treatment of testicular tumours in children ≤ 13, with the intention of evaluating the use of partial orchiectomy. From 1984 to 2008, we diagnosed and treated 15 testicular tumours in children at our centre. We examined the therapeutic approach employed, underlining the possibility of testicular conservation in selected patients and we have analysed the results. RESULTS: the clinical presentation in 80% of the cases was an increase in testicle size with palpable mass. We performed 4 radical orchiectomies (27%) and 11 tumourectomies (73%). All the benign lesions in the final pathological anatomy were treated with tumourectomy: four epidermoid cysts, one hemangioma, one lipoma, one fibrous hamartoma, one juvenile granulosa tumour and one splenogonadal fusion. We also successfully and conservatively treated two cases of teratoma. The cases that received radical treatment were a yolk sac tumour (Stage I), two mixed germ cell tumours and one gonadoblastoma. CONCLUSIONS: there are more cases of benign testicular tumours than malignant tumours during puberty. In the event of a palpable testicular mass with negative tumour markers, conservative treatment by means of a tumourectomy may be considered. However, the lesion must be removed completely to prevent recurrence.

Retrasplante renal: factores de riesgo y resultados / Renal retransplantation: risk factors and results

Objetivo: revisar nuestra experiencia en retrasplantes renales. Material y métodos: se realizó un estudio retrospectivo de 71 pacientes retrasplantados entre 1980 y 2005. Se analizaron: características del receptor e injerto, datos de la intervención, causas de pérdida del injerto, número de rechazos y trasplantectomías y supervivencia del injerto. Resultados: la causa más frecuente de pérdida del injerto fue el rechazo crónico. Las causas de pérdida del primer injerto no se asociaron con una mayor pérdida del segundo (p>0,05). El porcentaje de anticuerpos anti-HLA incrementó en el segundo trasplante respecto del primero (17,23±27,91% vs 1,21±7,43%) (p=0,001), pero no se correlacionó con un aumento significativo de pérdida del segundo injerto (p=0,320). No existieron diferencias significativas entre las complicaciones del primer y segundo trasplante (p>0,05) y no se asociaron con una pérdida del injerto (p>0,05). Los pacientes con una trasplantectomía en el primer trasplante presentaban un riesgo 8,5 veces mayor de sufrir una segunda (p=0,0001; OR: 8,54; IC 95%: 0,941 - 77,501). La causa más frecuente de trasplantectomía en el segundo trasplante fue el rechazo agudo. El rechazo agudo como causa de trasplantectomía en el primer trasplante se mostró como factor de riesgo independiente de trasplantectomía del segundo trasplante (p=0,009). La supervivencia media del segundo injerto fue de 5,08±4,81 años, superior al primer trasplante (p=0,133). La supervivencia del injerto a 1, 5 y 10 años fue del 83, 75 y 52%, respectivamente. Conclusiones: la supervivencia del segundo trasplante no es inferior al primero y tampoco existe incremento en el número de complicaciones (AU)

Objective: to review our experience in renal retransplantations. Materials and methods: we carried out a retrospective study on 71 patients with retransplantation performed between 1980 and 2005. We studied: the characteristics of the recipient and graft, surgery data, causes of loss of the graft, number of rejects and transplantectomies and, survival of the graft. Results: the most frequent cause of graft loss was chronic rejection. The causes of first graft loss were not associated with a greater loss of the second graft (p>0.05). The percentage of anti-HLA antibodies increased in the second transplant in comparison to the first (17.23±27.91% vs. 1.21±7.43%) (p=0.001), however, it was not correlated with a significant increase in loss of the second graft (p=0.320). There were no significant differences between the complications of the first and second transplants (p>0.05) and they were not associated with graft loss (p>0.05). The patients with a transplantectomy in the first transplant presented a risk 8.5 times higher of undergoing a second one (p=0.0001; OR: 8.54; CI: 95% 0.941 - 77.501). The most frequent cause of transplantectomies in the second transplant was acute rejection. Acute rejection as a cause for transplantectomy in the first transplant proved to be an independent risk factor of transplantectomy of the second transplant (p=0.009). The mean survival of the second graft was 5.08±4.81 years, higher than the first transplant (p=0.133). The survival of the graft at 1.5 and 10 years was 83%, 75% and 52%, respectively. Conclusions: the survival of the second transplant was not lower than the first, neither was there an increase in the number of complications (AU)

Ectasia piélica en diagnóstico prenata / Pyelic ectasia in prenatal diagnosis

La ecografía gestacional demuestra que el 1,4% de los fetos presentan algún grado de hidronefrosis, aunque en el 50%, dicha ectasia habrá desaparecido en el nacimiento. El desconocimiento que aún existe con respecto a las diferentes etapas del desarrollo fetal hace que sea difícil distinguir entre aquellas situaciones fisiológicas y las que son patológicas. La medición de los diámetros de la pelvis renal a lo largo de la gestación y la cantidad de líquido amniótico son datos importantes para establecer un pronóstico. Las válvulas de uretra posterior son las responsables de un buen número de casos de hidronefrosis gestacional significativa. Es importante diagnosticarlas y proceder a su tratamiento para evitar daño renal. Se presenta un caso clínico y se realiza una revisión sobre el tema proponiendo un algoritmo de actuación clínica (AU)

Gestational ultrasound shows that 1.4% of the fetuses have some degree of hydronephrosis, although in 50% renal ectasia will have disappeared at birth. The ignorance that still exists in the different stages of fetal development makes it difficult to distinguish between those situations that are physiological or pathological condition. Measuring the diameter of the renal pelvis throughout pregnancy and amniotic fluid are important data for establishing a prognosis. Posterior urethral valves are responsible for a number of significant cases of gestational hydronephrosis. It is important to diagnose it and provide treatment to prevent kidney damage. We present a case report and a review is made on the issue and we propos an algorithm for clinical intervention (AU)

Persistencia del seno urogenital: técnica quirúrgica mediante genitoplastia / Persistance of the urogenital sinus: surgical technique using genitoplasty

Las anomalías del seno urogenital (genitales ambiguos) consisten en la comunicación persistente de la vagina con el aparato urinario. Esta persistencia se observa en los recién nacidos con estados intersexuales, a los que actualmente se denomina desordenes de la diferenciación sexual (DDS). El tratamiento es quirúrgico. Presentamos un caso clínico de una niña de 4 años que presentaba un seno urogenital bajo, que fue tratada mediante genitoplastia (AU)

Eurogential sinus abnormalities (ambiguous genitalia) consist in the communication of the vagine with the urinary tract. This sinus persistence is observed in new borns with intersex states, which is now called disorders of sexual differentiation (DSD). The treatment is surgical. We present a case of a 4 year old girl who bad a low urogenital sinus, which was treated by genitoplasty (AU)

Persistencia del conducto peritoneo vaginal: revisión conceptual a propósito de un caso clínico / Persistence of the conduit vaginal peritoneum: conceptual review about a clinical case

La persistencia del conducto peritoneo-vaginal escrotal se debe a una falta de cierre del trayecto que, durante las etapas de desarrollo fetal, separan la cavidad peritoneal del escroto. Factores como la prematuridad o el bajo peso al nacer predisponen a esta alteración. Se presenta de diversas maneras: persistencia completa, parcial en forma de quiste de cordón e hidrocele con conducto cerrado. Es posible la asociación a hernia inguinal. Se puede producir su cierre espontánea en los 2 primeros años de vida. El tratamiento es quirúrgico, generalmente vía inguinal. Presentamos un caso clínico y una revisión sobre los aspectos básicos de esta entidad (AU)

The persistence e of the scrotum peritoneal-vaginal duct due to a lack of closure of the journey, during fetal development stages, separating the peritoneal cavity of the scrotum. Factors such as prematurity or low birth weight predispose to this disorder. It comes in different ways: full persistence, partly in the form of hydrocele and cord cyst with duct closed. Possible association with inguinal hernia is possible. Closure can occur spontaneously in the first 2 years of life. Treatment is surgical, usually transinguinal We present a case report and a review on the basic aspects of this entity (AU)

Disfunciones no neuropáticas del aparato urinario inferior en la infancia. A propósito de un caso / Non neuropathic dysfunctions of the low urinary system in childhood: one clinical case

Las disfunciones del aparato urinario inferior en la infancia (DNNTI.I) es un campo con gran confusión semántica. No existe una terminología común entre los diferentes grupos, usando distintas definiciones para describir lo mismo. Esta confusión refleja la investigación moderna, que en las últimas décadas nos ha hecho cambiar radicalmente nuestra visión sobre el tema, considerando que los niños son individuos en crecimiento, distintos a los adultos. La ICCS (International Children´s Continence Society), ha publicad las guías para intentar esclarecer esta confusión. Presentamos un caso clínico de hiperactividad del detrusor, y seguidamente un intento de clasificación de las DNNTI-I sin causa orgánica o neurológica (AU)

Lower urinary tract function and malfunction in children is a field rife with semantic confusion. Different groups use different definitions of commonly used terms. This confusion partly reflects modern research, which has radically changed our views of these conditions during the last decades, and partly the fact that children are growing individuals who differ from adults. The ICCS (International Children´s Continence Society), has published guidelines trying to clear-up this confusion. We present a clinical case of detrusor hyperactivity, and afterward an attempt to classify different lower urinary tract dysfunctions without organic or neurogenic cause (AU)

[Use of ureterocalicostomy in child]. / Uso de la ureterocalicostomía en la edad pediátrica.

INTRODUCTION: There are many clinical situations in wich it may be difficult to perform appropriately an anastomosis between the renal pelvis and the proximal portion of the uretersafely. Preservation of the organ depens upon the availability of surgical resources. In fact, that principle becomes particularipy significant when dealing with children. OBJECTIVES: To describe different clinical and surgical situations in wich the successful performance of ureterocalicostomy has enable us to maintain three renal units with function from child patients and without complications. METHOD AND PATIENTS: Three children aged 8, 4 and 1 year were submitted to surgery because of pyelocaliceal lithiasis in the first case and secundary ureteropelvic stenosis in the remaning two cases. RESULTS: With a median follow-up of 12 months, all three renal units were preserved and, according to the isotopic study, functionality was improved in the two cases of ureteropelvic obstruction and the normal preoperative function was preserved in the first case. No complications occurred either during the immediate postoperative period or up to the date of this review. CONCLUSION: Ureterocalicostomy should be considered a suitable alternative in different clinical situations in wich the ureteropelvic continuity could be compromised, or in cases of indundibulopelvic stenosis.

Prevention of vesicoureteral reflux at the time of complete primary repair of the exstrophy-epispadias complex.

INTRODUCTION: With Mitchell's technique it is possible to perform bladder closure, reconstruction of epispadias and the bladder neck in one single procedure in an exstrophy patient. However the most common postoperative complication is pyelonephritis secondary to vesicouretral reflux. Reflux is closely linked to bladder exstrophy due to an abnormal anatomic development of the distal ureteral segment and to a pathologic bladder disposition. This problem is normally solved in subsequent surgical procedures. TECHNICAL CONSIDERATIONS: We decided to apply the technique described by Gil-Vernet as a first step of a bladder exstrophy repair following the Mitchell's technique. This ureteral advancement by means of trigonoplasty is a simple surgical procedure for vesicouretral reflux that preserves the intrinsic and extrinsic periureteral musculature. It is quite a short procedure that has yielded rates of success over 90%. CONCLUSIONS: The realization of this antireflux technique together with the primary closure could avoid later surgical correction in patients whose have had multiple operations.

[Living donor nephrectomy for kidney transplantation. Experience in the first two years]. / Nefrectomía laparoscópica de donante vivo para trasplante renal. Los dos primeros años de experiencia.

OBJECTIVES: Laparoscopic surgery offers potential advantages in terms of diminishment of postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. These advantages may increase kidney donation, making donation be accepted by more candidates. We report our first 2 years' experience with laparoscopic donor nephrectomy METHODS: Between March 2002 and February 2004 we performed 38 laparoscopic living donor nephrectomies for kidney transplantation. The technique of choice was the transperitoneal laparoscopic approach with four trocars, usually three of them from the start of the procedure--two 10-12 mm and one 5 mm--, and a 6.5 cm perumbilical midline incision for kidney retrieval at the end of the procedure. RESULTS: Receptor and donor survivals were 100%. Graft survival was 97.6%. There was not any case of delayed graft function. Donor: Mean operative time was 161 minutes (115-260). Mean estimated blood loss was 270 ml (100-1200). Three patients required blood transfusions, 2 units of packed red blood cells each. Mean hospital stay was 5.1 days (3-11). Mean warm ischemia time was 3.2 min. (2-10). Conversion to open surgery was necessary in four cases. Receptor: there have been three significant complications requiring surgical repair: one case of low arterial flow, one vesico ureteral leak, and one midurethra stenosis. Initial renal function: mean serum creatinine at one month was 147mmol/l, with a trend to improve to 126 mmol/l at one year, which is considered optimum. First postoperative day mean serum creatinine was 192mmol/l and the nadir was on second postoperative day with a value of 152mmol/l. CONCLUSIONS: We believe laparoscopic living donor nephrectomy is a real alternative to open surgery because it offers better recovery to the donor with the same capacity to preserve renal function in the receptor.

Pólipo fibroepitelial vesical en infancia / No disponible

El pólipo fibroepitelial es una neoplasia benigna de origen mesodérmico que puede originarse a lo largo de todo el epitelio genitourinario, desde cálices a uretra. Es poco frecuente en el aparato genitourinario y excepcional en la vejiga de niños. Se presenta un caso en paciente de 10 años que debutó con cuadro de hematuria monosintomática, diagnosticado mediante ecografía y tratado por resección transuretral. Se discute la bibliografía disponible sobre el tema (AU)

Fibroepithelioma polyps is a being mesodermic neoplasia, that arise anywhere along the genitourinary tract, from calyx to urethra. Althought it's common in another sites, it isn't in the genitourinary surface and it's excepcional in the children's bladder. We present a ten years old man who presented gross haematuria, diagnosticated by ecography and treated endoscopically. This disease's available literature is discused subsequently (AU)