Administración de contraste hidrosoluble para el tratamiento de las oclusiones intestinales por adherencias / Administration of water-soluble contrast for the treatment of adhesive intestinal occlusion

Objetivos. El tránsito gastrointestinal con contraste hidrosoluble se utiliza desde hace años en el tratamiento de las obstrucciones intestinales por adherencias (OIA) en adultos. Nuestro objetivo es comparar un grupo de niños con OIA tratados con contraste hidrosoluble con un grupo control. Material y métodos. Realizamos un estudio de casos y controles que incluye pacientes con antecedentes de cirugía abdominal y OIA entre 2008 y 2013. Los controles fueron tratados de forma conservadora o cirugía según evolución y los casos admitidos como OIA a partir de diciembre de 2012 se les aplicó tratamiento con contraste hidrosoluble. La variable principal es la necesidad de cirugía y las variables secundarias, la estancia hospitalaria y las complicaciones. Resultados. Se han recogido 20 controles y 8 casos. La necesidad de cirugía en el grupo control ha sido del 50% y del 25% en los casos tratados con contraste (p > 0,05). La estancia hospitalaria en el grupo control ha sido de 6 días frente a 4 días en el grupo a estudio (p > 0,05). Se han observado un 20% de complicaciones entre los controles y ninguna complicación en los casos. Conclusiones. Aunque no hemos encontrado diferencias significativas debido al pequeño tamaño de la muestra, sí se ha observado una tendencia de menor necesidad de cirugía en los casos tratados con contraste hidrosoluble. Nuestra experiencia preliminar sugiere que el contraste hidrosoluble puede ser una alternativa eficaz y sin complicaciones en el tratamiento de la oclusión intestinal por adherencias en niños, por lo que proponemos la realización de un estudio multicéntrico para aumentar la muestra y poder definir conclusiones más certeras

Objective. The water-soluble contrast has shown its effectiveness for the resolution of adhesive small bowel obstruction (SBO) in adults. The objective of this study is to compare the value of water-soluble contrast in children with SBO versus control group. Methods. We conducted a case-control trial. Patients with a history of abdominal surgery and SBO diagnosed between 2008 and 2013 were included as controls. Conservative treatment or surgery depending on clinical evolution was performed in control group. The patients with SBO diagnosed from December 2012 were treated with water-soluble contrast. The main variable was the number of patients requiring surgery and the hospital stay and complications were the secondary variable. Results. Twenty controls and 8 cases were admitted with SBO. Surgery was required in 50% of control group patients and 25% in the contrast group (p > 0.05). The hospital stay length was 6 days in control group versus 4 days in study group (p > 0.05). No complications were attributed to the use of water-soluble contrast and 20% of complications happened in control group. Conclusions. The need for surgery was lower in study group but not statically significant due to the small size of the sample. We concluded that water-soluble contrast is safe and effective in the management of SBO in children. We propose a multicentre study

Balanitis xerótica obliterante, patología infradiagnosticada de relevancia clínica / Balanitis xerotica obliterans, underdiagnosed pathology of clinical relevance

Objetivos. La balanitis xerotica obliterante (BXO) es una enfermedad crónica inflamatoria, variante del liquen escleroso, que afecta a los genitales masculinos. Presentamos nuestra incidencia de BXO y una revisión de la literatura. Material y métodos. Estudio retrospectivo descriptivo de pacientes operados de circuncisión entre abril de 2013 y abril 2014 por fimosis persistente a los 4 años, clínica miccional o con la erección. Se enviaron muestras para estudio patológico de aquéllos con sospecha clínica de BXO. Resultados. Se circuncidaron 339 pacientes. La edad media de intervención fue 6,5 años (Mediana 5 y Moda 4). Once casos (3,9%) fueron diagnosticados de BXO, con una edad media de 8,2 años (6-12 años). Se enviaron 16 muestras (5,7%) para análisis anatomopatológico (AP) por sospecha clínica de BXO, 9 presentaban fimosis cicatricial (2 con estenosis del meato uretral), 1 balanitis, 2 fimosis con prepucio o glande descamativo, 1 retención urinaria aguda por balanitis y 1 reestenosis prepucial. En 10 casos se confirmó liquen escleroátrofico, 2 inflamaciones crónicas, 1 patrón liquenoide y otro normal. Tres pacientes precisaron, además, meatotomía. Los pacientes con BXO fueron tratados con corticoides tópicos postcircuncisión en 10 casos. Conclusiones. Nuestra incidencia es baja en relación a la literatura (10-40% según las series) ya que no remitimos a estudio AP el prepucio de forma rutinaria. La sospecha clínica subestima la incidencia real de BXO hasta en 49% según algunos autores. La circuncisión es curativa en la mayoría de los casos con BXO. La BXO además de producir estenosis del meato y alteraciones uretrales, está relacionado con una alta incidencia de carcinoma de pene

Objectives. Balanitis xerotica obliterans (BXO) is a chronic inflamatory disease, a genital form of Lichen Sclerosus in males. Material and methods. This retrospective and descriptive analysis was carried out by rewiew of the medical records of boys who underwent circumcision from April 2013 to April 2014. The study group consisted of boys that were circumcised due it persistant phimosis at 4 years of age, urinary symptoms or painful erection. The histopathological examination was performed only in patients with clinical suspicion of BXO. Results. 339 patients were circumcised. The mean age of surgery was 6.5 years (Median 5, Mode 4). BXO was confirmed in eleven boys (3.9%) out of 16 biopsies (5.7%), with a mean age of 8.2 years (6-12). Of all the biopsies that were analysed for clinical BXO, 9 had scarring phimosis (2 meatal stenosis), 2 had balanitis and 1 had acute urinary retention, 2 presented descamative foreskin or glands, and 1 had recurrent phimosis. The histopathological examination revealed lichen sclerosus in 10 patients. Meatotomy was performed in 3 boys, one of them in during the follow-up period. 10 patients with BXO were treated with topical corticosteroid cream after circumcision. Conclusions. Our incidence is low in compared to literature (10- 40%) as we did not refer the foreskin routinely to histopathological analysis. The clinical suspicion underestimates the incidence of BXO up to 49%. The circumcision is curative in most cases with BXO. The BXO may produce meatoestenosis and urethral abnormalities, and it is associated with a high incidence of penile carcinoma of the penis

Válvulas de uretra anterior y divertículo de uretra anterior, ¿son la misma entidad? / Anterior urethral valves and anterior urethral diverticulum, are they same entity?

Objetivos. Presentamos nuestra experiencia en el diagnóstico y manejo de los divertículos de uretra anterior (DUA) y de las válvulas de uretra anterior (VUA), junto con revisión de la bibliografía. Material y métodos. Se ha realizado un estudio retrospectivo de casos con DUA o VUA tratados en los últimos 10 años en nuestro servicio. En todos los casos se efectuó exploración física, estudio de función renal y ecografía renal. El diagnóstico se completó con cistografía miccional y cistoscopia, así como estudio nuclear, en los casos subsidiarios. Resultados. Han sido diagnosticados 4 niños. Se sospechó la presencia de VUA en aquellos pacientes en los que se objetivó en la cistografía un cambio de calibre de la uretra anterior con imagen sugestiva de vejiga de lucha. Estos hallazgos, observados en la mitad de los casos, coincidieron con los niños con presentación neonatal. El diagnóstico se confirmó mediante cistoscopia, que permitió la resección endoscópica simultánea. Los pacientes con DUA fueron tratados quirúrgicamente mediante resección del divertículo y uretroplastia. Solo un caso, el cual presentaba VUA, ha tenido afectación renal en el estudio nuclear, sin repercusión en la filtración glomerular. Conclusiones. En nuestra experiencia, las VUA y DUA se comportan como dos entidades diferentes en cuanto a clínica y necesidad de tratamiento. Las VUA han sido tratadas eficazmente con cirugía endoscópica y los DUA aislados han precisado de cirugía abierta, al igual que se describe en la literatura

Objetive. We present our experience in the diagnosis and management of anterior urethral valves (AUV) and anterior urethral diverticula (AUD) as well as review of the bibliography. Materials and methods. We retrospectively evaluated all the cases of the AUV and AUD treated in our hospital during the last 10 years. The clinical exploration, renal function study and renal and bladder ultrasound were evaluated in all the children. The diagnosis was completed with voiding cystography (VCUG) and cystoscopy as well as nuclear study in the relevant patients. Results. Four patients have been treated in our center. AUV was suspected in those children with narrowing of the anterior urethra and thickened bladder with trabeculations at the VCUG. These findings were noticed in 50% of the patients, which also had a neonatal presentation. The diagnosis was confirmed by cystoscopy that allowed the endoscopic resection at the same procedure. The boys with AUD were managed by excision of the diverticulum with urethroplasty. On the follow up, one patient who had AUV, presented renal involvement in the nuclear scans with normal renal function. Conclusion. In our experience, the AUV and AUD behave as two different entities in terms of clinical presentation and treatment. The AUV have been effectively treated with endoscopic surgery and the AUD have pointed out open surgery, as described in the literatura

[Anterior urethral valves and anterior urethral diverticulum, are they same entity?] / Válvulas de uretra anterior y divertículo de uretra anterior, ¿son la misma entidad?

OBJECTIVE: We present our experience in the diagnosis and management of anterior urethral valves (AUV) and anterior urethral diverticula (AUD) as well as review of the bibliography. MATERIALS AND METHODS: We retrospectively evaluated all the cases of the AUV and AUD treated in our hospital during the last 10 years. The clinical exploration, renal function study and renal and bladder ultrasound were evaluated in all the children. The diagnosis was completed with voiding cystography (VCUG) and cystoscopy as well as nuclear study in the relevant patients. RESULTS: Four patients have been treated in our center. AUV was suspected in those children with narrowing of the anterior urethra and thickened bladder with trabeculations at the VCUG. These findings were noticed in 50% of the patients, which also had a neonatal presentation. The diagnosis was confirmed by cystoscopy that allowed the endoscopic resection at the same procedure. The boys with AUD were managed by excision of the diverticulum with urethroplasty. On the follow up, one patient who had AUV, presented renal involvement in the nuclear scans with normal renal function. CONCLUSION: In our experience, the AUV and AUD behave as two different entities in terms of clinical presentation and treatment. The AUV have been effectively treated with endoscopic surgery and the AUD have pointed out open surgery, as described in the literature.

OBJETIVOS: Presentamos nuestra experiencia en el diagnóstico y manejo de los divertículos de uretra anterior (DUA) y de las válvulas de uretra anterior (VUA), junto con revisión de la bibliografía. MATERIAL Y METODOS: Se ha realizado un estudio retrospectivo de casos con DUA o VUA tratados en los últimos 10 años en nuestro servicio. En todos los casos se efectuó exploración física, estudio de función renal y ecografía renal. El diagnóstico se completó con cistografía miccional y cistoscopia, así como estudio nuclear, en los casos subsidiarios. RESULTADOS: Han sido diagnosticados 4 niños. Se sospechó la presencia de VUA en aquellos pacientes en los que se objetivó en la cistografía un cambio de calibre de la uretra anterior con imagen sugestiva de vejiga de lucha. Estos hallazgos, observados en la mitad de los casos, coincidieron con los niños con presentación neonatal. El diagnóstico se confirmó mediante cistoscopia, que permitió la resección endoscópica simultánea. Los pacientes con DUA fueron tratados quirúrgicamente mediante resección del divertículo y uretroplastia. Solo un caso, el cual presentaba VUA, ha tenido afectación renal en el estudio nuclear, sin repercusión en la filtración glomerular. CONCLUSIONES: En nuestra experiencia, las VUA y DUA se comportan como dos entidades diferentes en cuanto a clínica y necesidad de tratamiento. Las VUA han sido tratadas eficazmente con cirugía endoscópica y los DUA aislados han precisado de cirugía abierta, al igual que se describe en la literatura.

[Administration of water-soluble contrast for the treatment of adhesive intestinal occlusion]. / Administración de contraste hidrosoluble para el tratamiento de las oclusiones intestinales por adherencias.

OBJECTIVE: The water-soluble contrast has shown its effectiveness for the resolution of adhesive small bowel obstruction (SBO) in adults. The objective of this study is to compare the value of water-soluble contrast in children with SBO versus control group. METHODS: We conducted a case-control trial. Patients with a history of abdominal surgery and SBO diagnosed between 2008 and 2013 were included as controls. Conservative treatment or surgery depending on clinical evolution was performed in control group. The patients with SBO diagnosed from December 2012 were treated with water-soluble contrast. The main variable was the number of patients requiring surgery and the hospital stay and complications were the secondary variable. RESULTS: Twenty controls and 8 cases were admitted with SBO. Surgery was required in 50% of control group patients and 25% in the contrast group (p>0.05). The hospital stay length was 6 days in control group versus 4 days in study group (p>0.05). No complications were attributed to the use of water-soluble contrast and 20% of complications happened in control group. CONCLUSIONS: The need for surgery was lower in study group but not statically significant due to the small size of the sample. We concluded that water-soluble contrast is safe and effective in the management of SBO in children. We propose a multicentre study.

OBJETIVOS: El tránsito gastrointestinal con contraste hidrosoluble se utiliza desde hace años en el tratamiento de las obstrucciones intestinales por adherencias (OIA) en adultos. Nuestro objetivo es comparar un grupo de niños con OIA tratados con contraste hidrosoluble con un grupo control. MATERIAL Y METODOS: Realizamos un estudio de casos y controles que incluye pacientes con antecedentes de cirugía abdominal y OIA entre 2008 y 2013. Los controles fueron tratados de forma conservadora o cirugía según evolución y los casos admitidos como OIA a partir de diciembre de 2012 se les aplicó tratamiento con contraste hidrosoluble. La variable principal es la necesidad de cirugía y las variables secundarias, la estancia hospitalaria y las complicaciones. RESULTADOS: Se han recogido 20 controles y 8 casos. La necesidad de cirugía en el grupo control ha sido del 50% y del 25% en los casos tratados con contraste (p>0,05). La estancia hospitalaria en el grupo control ha sido de 6 días frente a 4 días en el grupo a estudio (p>0,05). Se han observado un 20% de complicaciones entre los controles y ninguna complicación en los casos. CONCLUSIONES: Aunque no hemos encontrado diferencias significativas debido al pequeño tamaño de la muestra, sí se ha observado una tendencia de menor necesidad de cirugía en los casos tratados con contraste hidrosoluble. Nuestra experiencia preliminar sugiere que el contraste hidrosoluble puede ser una alternativa eficaz y sin complicaciones en el tratamiento de la oclusión intestinal por adherencias en niños, por lo que proponemos la realización de un estudio multicéntrico para aumentar la muestra y poder definir conclusiones más certeras.

[Balanitis xerotica obliterans, underdiagnosed pathology of clinical relevance]. / Balanitis xerótica obliterante, patología infradiagnosticada de relevancia clínica.

OBJECTIVES: Balanitis xerotica obliterans (BXO) is a chronic inflamatory disease, a genital form of Lichen Sclerosus in males. MATERIAL AND METHODS: This retrospective and descriptive analysis was carried out by rewiew of the medical records of boys who underwent circumcision from April 2013 to April 2014. The study group consisted of boys that were circumcised due it persistant phimosis at 4 years of age, urinary symptoms or painful erection. The histopathological examination was performed only in patients with clinical suspicion of BXO. RESULTS: 339 patients were circumcised. The mean age of surgery was 6.5 years (Median 5, Mode 4). BXO was confirmed in eleven boys (3.9%) out of 16 biopsies (5.7%), with a mean age of 8.2 years (6-12). Of all the biopsies that were analysed for clinical BXO, 9 had scarring phimosis (2 meatal stenosis), 2 had balanitis and 1 had acute urinary retention, 2 presented descamative foreskin or glands, and 1 had recurrent phimosis. The histopathological examination revealed lichen sclerosus in 10 patients. Meatotomy was performed in 3 boys, one of them in during the follow-up period. 10 patients with BXO were treated with topical corticosteroid cream after circumcision. CONCLUSIONS: Our incidence is low in compared to literature (10-40%) as we did not refer the foreskin routinely to histopathological analysis. The clinical suspicion underestimates the incidence of BXO up to 49%. The circumcision is curative in most cases with BXO. The BXO may produce meatoestenosis and urethral abnormalities, and it is associated with a high incidence of penile carcinoma of the penis.

OBJETIVOS: La balanitis xerotica obliterante (BXO) es una enfermedad crónica inflamatoria, variante del liquen escleroso, que afecta a los genitales masculinos. Presentamos nuestra incidencia de BXO y una revisión de la literatura. MATERIAL Y METOODS: Estudio retrospectivo descriptivo de pacientes operados de circuncisión entre abril de 2013 y abril 2014 por fimosis persistente a los 4 años, clínica miccional o con la erección. Se enviaron muestras para estudio patológico de aquéllos con sospecha clínica de BXO. RESULTADOS: Se circuncidaron 339 pacientes. La edad media de intervención fue 6,5 años (Mediana 5 y Moda 4). Once casos (3,9%) fueron diagnosticados de BXO, con una edad media de 8,2 años (6-12 años). Se enviaron 16 muestras (5,7%) para análisis anatomopatológico (AP) por sospecha clínica de BXO, 9 presentaban fimosis cicatricial (2 con estenosis del meato uretral), 1 balanitis, 2 fimosis con prepucio o glande descamativo, 1 retención urinaria aguda por balanitis y 1 reestenosis prepucial. En 10 casos se confirmó liquen escleroátrofico, 2 inflamaciones crónicas, 1 patrón liquenoide y otro normal. Tres pacientes precisaron, además, meatotomía. Los pacientes con BXO fueron tratados con corticoides tópicos postcircuncisión en 10 casos. CONCLUSIONES: Nuestra incidencia es baja en relación a la literatura (10-40% según las series) ya que no remitimos a estudio AP el prepucio de forma rutinaria. La sospecha clínica subestima la incidencia real de BXO hasta en 49% según algunos autores. La circuncisión es curativa en la mayoría de los casos con BXO. La BXO además de producir estenosis del meato y alteraciones uretrales, está relacionado con una alta incidencia de carcinoma de pene.

[Fertility survey of patients operated on of cryptorchidism in the pediatric age]. / Encuesta de fertilidad en pacientes operados de criptorquidia en edad pediátrica.

OBJECTIVES: To analyze the fertility survey made in a cohort of adults operated on as children for cryptorchidism and for whom clinical and surgical data is available and who were studied 10 years ago by spermiogram and hypophyseal axis. METHODS: A fertility survey including data on style of life and work conditions was sent to the homes of 278 adult patients operated on for cryptorchidism. The 94 surveys received (33.8% of those sent) were analyzed using the SPSS 15.0, carrying out a descriptive and analytic study. We consider persons who achieve pregnancy within a maximum of 12 months with regular sexual activity without the use of contraceptives as having normal fertility. RESULTS: A total of 53 cases of those surveyed (56.4%) attempted to have children, 44 (83.1%) being successful. A total of 34 patients (64.2%) were considered fertile with a mean time of 4.15 months to become pregnant. Nineteen patients (35.8%) had attempted to become parents for more than 12 months and only 10 achieved it (18.9%), 5% in a natural way, 2 with ovulation treatment and 3 by in vitro fertilization, with a mean of 26.8 months. There was no success in becoming parents in 9 cases (16.9%). There are no significant differences between fertilization and localization in laterality of the testicle, age at time of surgery and density on spermiogram. There are significant differences between natural paternity and unilateral or bilateral cryptorchidia. CONCLUSIONS: There is a greater proportion of unilateral cryptorchidias in the group that was successful in having children. We need to increase the number of those surveyed in order to draw significant conclusions in regards to fertility and other clinical situations.

Triada de Currarino: sus diferentes formas de presentación / Currarino triad: Different forms of presentation

Objetivos. Presentar nuestra experiencia en casos diagnosticados de síndrome de Currarino y sus diferentes formas de presentación. material y métodos. Caso 1: neoanata con diagnóstico prenatal por RM de mielomeningocele confirmado al nacimiento como lipomielomeningocele asociado a atresia ano-rectal alta con vascularización anómala del colon, agenesia parcial sacra y riñón en herradura. Caso 2: varón de 14 meses con clínica de estreñimiento y diagnóstico de estenosis anal, lipomeningocele presacro más teratoma y agenesia parcial sacra. Caso 3: varón de 8 meses con clínica de meningitis de repetición y diagnosticado de estenosis anal, meningocele anterior con fístula rectal y agenesia parcial sacra. Resultados. El caso 1 tras un descenso abdomino-perineal fallido por vascularización anómala es portadora actual de cecostomía y a los 3 años de vida presenta un buen control urinario y de la deambulación. El caso 2, con dos años de vida, evoluciona favorablemente con hábito intestinal normal tras extirpación del teratoma y meningocele más dilatación anal. El caso 3 precisó una colostomía tras extirpación del meningocele con fístula rectal por fístula recto-cutánea en el postoperatorio inmediato y derivación ventriculoperitoneal por hidrocefalia postmeningitis. Conclusiones. Según la bibliografía, la forma de presentación del síndrome de Currarino (SC) puede ser muy variada, siendo lo más frecuente el estreñimiento. La presentación más compleja y con alto índice de mortalidad (56%) es la meningitis de repetición debido a fístulas recto-meníngeas. La malformación ano-rectal más frecuente es la estenosis anal y malformaciones más complejas tienen un alto índice de incontinencia. Es un síndrome que precisa de manejo y seguimiento multidisciplinar (AU)

Background. We describe our experience in Currarino syndrome (CS) and our clinical findings. methods. Case 1: Newborn female with prenatal diagnosis of myelomeningocele which was confirmed at birth as a lipomyelomeningocele, associated with partial sacral agenesis, horseshoe kidney and complex anorectal malformation with colonic vascular anomaly. Case 2: A 14-month-old male with constipation. The physical examination detected an anal stricture and radiological findings of a presacral lipomeningocele plus teratoma and a partial sacral agenesis. Case 3:An 8-month-old male with recurrent meningitis associated with anterior sacral meningocele and rectal fistula. An anal stricture and hemisacrum were also demonstrated. Results. In case 1, an abdomino-perineal pull-through was performed but it failed because of her colonic vascular anomaly. Nowadays she is 3 years old and has a cecostomy, controls her micturition and is able to walk. Case 2 is two years old with satisfactory flow-up-after the teratoma and meningocele removal plus anal dilation. In case 3 a colostomy was necessary because after mass excision a recto-cutaneous fistula appeared during postoperative period. A ventriculoperitoneal valve implantation due to his hydrocephaly was also performed. Conclusions. The constipation is the most common symptom in the CS. Recurrent meningitis has a high mortality rate (56%) due to rectomeningeal fistula. The most common anorectal malformation is the anal stricture, and the more complex the malformation is, higher will the risk of incontinence be. The success of the management and follow-up is a multidisciplinary responsability (AU)

Encuesta de fertilidad en pacientes operados de criptorquidia en edad pediátrica / Fertility survey of patients opened on of cryptorchidism in the pediatric ag

Objetivos. Analizar la encuesta de fertilidad realizada en una cohorte de adultos, operados de criptorquidia en edad pediátrica, de los que disponemos datos clínicos y quirúrgicos y que fueron estudiados hace 10 años, realizando un espermiograma y un estudio del eje hipofisario. Métodos. Se envió una encuesta de fertilidad, incluyendo datos de estilo de vida y condiciones de trabajo al domicilio de 278 pacientes adultos operados de criptorquidia. Las 94 encuestas recibidas (33,8% de las enviadas) han sido analizadas con SPSS 15.0, realizando un estudio descriptivo y analítico. Consideramos que tienen fertilidad normal aquellas personas que consiguen el embarazo en un máximo de 12 meses con actividad sexual regular sin uso de anticonceptivos. Resultados. Han intentado tener hijos 53 casos de los encuestados (56,4%) y lo han conseguido 44 (83,1%). Han sido considerados fértiles 34 pacientes (64,2%) con una media de tiempo para embarazarse de 4,15 meses. Diecinueve pacientes (35,8%) han intentado ser padres durante más de 12 meses y lo han conseguido sólo 10 (18,9%), 5 de forma natural, 2 con tratamiento ovulatorio y 3 por FIV, con una media de 26,8 meses. No han conseguido ser padres 9 casos (16,9%). No existen diferencias significativas entre fertilidad y localización y lateralidad del testículo, edad de cirugía y densidad del espermiograma. Existen diferencias significativas entre paternidad natural y la uni o bilateralidad de la criptorquidia. Conclusiones. Existe mayor proporción de criptórquidos unilaterales en el grupo que ha llegado a ser padres. Necesitamos ampliar el número de encuestados para poder sacar conclusiones significativas en cuanto a la fertilidad en otras situaciones clínicas (AU)

Objectives. To analyze the fertility survey made in a cohort of adults operated on as children for cryptorchidism and for whom clinical and surgical data is available and who were studied 10 years ago by spermiogram and hypophyseal axis. Methods. A fertility survey including data on style of life and work conditions was sent to the homes of 278 adult patients operated on for cryptorchidism. The 94 surveys received (33.8% of those sent) were analyzed using the SPSS 15.0, carrying out a descriptive and analytic study. We consider persons who achieve pregnancy within a maximum of 12 months with regular sexual activity without the use of contraceptives as having normal fertility. Results. A total of 53 cases of those surveyed (56.4%) attempted to have children, 44 (83.1%) being successful. A total of 34 patients (64.2%) were considered fertile with a mean time of 4.15 months to become pregnant. Nineteen patients (35.8%) had attempted to become parents for more than 12 months and only 10 achieved it (18.9%), 5% in a natural way, 2 with ovulation treatment and 3 by in vitro fertilization, with a mean of 26.8 months. There was no success in becoming parents in 9 cases (16.9%). There are no signifi cant differences between fertilization and localization in laterality of the testicle, age at time of surgery and density on spermiogram. There are significant differences between natural paternity and unilateral or bilateral cryptorchidia. Conclusions. There is a greater proportion of unilateral cryptorchidias in the group that was successful in having children. We need to increase the number of those surveyed in order to draw signifi cant conclusions in regards to fertility and other clinical situation (AU)

[Currarino triad: different forms of presentation]. / Triada de Currarino: sus diferentes formas de presentación.

BACKGROUND: We describe our experience in Currarino syndrome (CS) and our clinical findings. METHODS: Case 1: Newborn female with prenatal diagnosis of myelomeningocele which was confirmed at birth as a lipomyelomeningocele, associated with partial sacral agenesis, horseshoe kidney and complex anorectal malformation with colonic vascular anomaly. Case 2: A 14-month-old male with constipation. The physical examination detected an anal stricture and radiological findings of a presacral lipomeningocele plus teratoma and a partial sacral agenesis. Case 3: An 8-month-old male with recurrent meningitis associated with anterior sacral meningocele and rectal fistula. An anal stricture and hemisacrum were also demonstrated. RESULTS: In case 1, an abdomino-perineal pull-through was performed but it failed because of her colonic vascular anomaly. Nowadays she is 3 years old and has a cecostomy, controls her micturition and is able to walk. Case 2 is two years old with satisfactory flow-up-after the teratoma and meningocele removal plus anal dilation. In case 3 a colostomy was necessary because after mass excision a recto-cutaneous fistula appeared during postoperative period. A ventriculoperitoneal valve implantation due to his hydrocephaly was also performed. CONCLUSIONS: The constipation is the most common symptom in the CS. Recurrent meningitis has a high mortality rate (56%) due to rectomeningeal fistula. The most common anorectal malformation is the anal stricture, and the more complex the malformation is, higher will the risk of incontinence be. The success of the management and follow-up is a multidisciplinary responsability.

Nuestra experiencia con el uso de alfa-líticos en el tratamiento de la disfunción de vaciado / Our experience with the use of alpha-lithic therapy in the treatment of voiding dysfunction

Introducción. El vaciamiento disfuncional (VD) se debe a una disfunción en la musculatura del suelo pélvico, ocasionado por una hiperactividad del esfínter uretral y de la musculatura de esa zona durante la fase de vaciado del ciclo miccional. Los tratamientos utilizados son recomendar hábitos miccionales correctos, biofeedback y ejercicios de relajación pélvica. En la actualidad, también se utilizan fármacos, como alfalíticos e injección de toxina botulínica, pero su experiencia en niños es escasa. Objetivos. Mostrar nuestra experiencia con el uso de alfalíticos en pacientes con VD. Material y métodos. Revisión de los pacientes con VD tratados con alfa-líticos en nuestro servicio. Resultados. 6 pacientes con VD fueron tratados con alfa-líticos(Alfuzosina o Doxazosina). Niña (12 años) con síndrome de Wolfram (..) (AU)

Introduction. Dysfunctional voiding (DV) is due to a dysfunction in the pelvis floor muscles caused by hyperactivity of the urethral sphincter and the musculature of this zone during the voiding phase of the micturition cycle. The treatments used are recommending correct micturition habits, biofeedback and pelvic relaxation exercises. Currently, drugs are also used, such as alpha lithic drugs and injection of botulinic toxin, however its experience in children is limited. Objectives. Show our experience with the use of alpha-lithics inpatients with DV. Material and methods. Review of patients with DV treated with alpha-lithics in our institution .Results. 6 patients with DV were treated with alpha-lithics (Alfuzosin or Doxazosin). Girl (12 years) with Wolfram Syndrome with significant post-void residual urine, who initially rejected intermittent catéter. Residual urine decreases slightly with treatmente, but isn´t (..) (AU)

[The PEG: why wait?]. / La PEG: ¿Por qué esperar?

UNLABELLED: The swallowing disorder is an impediment to feed the patient. The percutaneous endoscopic gastrostomy (PEG) offers importants advantages over nasogastric tube feeding in patients who need long-term enteral nutrition with difficulty to swallow and to failure to thrive. METHODS: We have achieved 40 PEG in our department over the past 10 years. We registered date of the age, weight, indications, types of PEG, the time to first change, evolution of weight and percentiles and the complications. RESULTS: The average age of our patients was 5 years, 30% under 1 year. We used mostly tubes between 9 and 15 Fr and increasing the size according to nutritional needs. The average weight at the time of PEG placement was 13 kg. The main indications were the impossibility to swallow and failure to thrive and the principal diagnosis was the encephalopathy in 45% of cases. The surgical technique was successful in 100%. Of the complications, only two patients required surgery, a gastrocolic fistula and a laparotomy about broken tube of gastrostomy that has been caught in the cecum. In our series we reported 11 cases of mortality from causes unrelated to the gastrotmy. CONCLUSIONS: The PEG is a good alternative to nasogastric tube in patients with swallowing disorders or failure to thrive in chronic diseases, even in children under one year. The early placement of the PEG support the growth development in these patients with chronic disease who require enteral nutrition for long periods. Probably, the time of placement should be more precocious in chronic patients as well tolerated and may have a long life with a good care.

[Differential diagnosis of the interlabial masses in girls under 5-years-old]. / Diagnóstico diferencial de las masas interlabiales en niñas menores de 5 años.

UNLABELLED: The masses that we can be found at interlabial in a girl are a extensive spectrum of heterogenous lesions and often there is a confusion in diagnosis, management and prognosis. METHODS: We present 5 cases of interlabial masses, prolapsed urethra, two paraurethral Skene cysts, botryoid sarcoma and fibroepithelial polyp, and its clinical of debut. RESULTS: A prolapsed urethra is presented in a 4-year-old black girl with vaginal bleeding from edamatous periurethral mass. The paraurethral cyst is a yellowish cystic mass displacing the urethral meatus in two newborn girls. The fibroepithelial polyp is presented in a newborn girl as polipoid and wartlike tumor and not bleeding injury in the introitus. The botryoid sarcoma appears in a 1-year-old girl with ulcerated polypoid mass of 2 cm from vagina. All cases were treated with surgery except the paraurethral cyst that drained spontaneously and the rhabdomyosarcoma was also treated with chemotherapy. CONCLUSIONS: There must be a good clinical examinations about interlabial masses distinguishing genital or urological origin. The surgery is indicated mainly to reject malignancy because the presentation of sarcoma and polyp could be similar. The prognosis of rhabdomyosarcoma vaginal is good with surgery and chemotherapy. The prolapsed urethra is more common in prepubertal black girls and it is important to exclude sexual abuse. The management of paraurethral cyst is controversial but some authors are advised first observation because they may regress.

Nuestra experiencia en el paciente politraumatizado pediátrico con criterios de ingreso en UCI / Our experience in the poly-traumatized pediatric patient with criteria for admission to the ICU

Objetivo. Presentar nuestra experiencia en el politraumatizado grave con ingreso en UCI pediátrica. Material y método. Se ha realizado un estudio retrospectivo de 78pacientes pediátricos ingresados en UCI por politraumatismo entre 2000y 2008 recogiendo variables de edad, sexo, época del año, lugar, mecanismo, Glasgow e ITP, tipo de lesiones, complicaciones, días de ingreso y fallecimientos. Se lleva a cabo el estudio descriptivo y analítico utilizando el SPSS 15.0 aplicando Chi cuadrado y Correlación de Pearson. Resultados. La edad media de los pacientes es de 8,5 ± 4,2 años siendo el 70% varones. Ocurren más accidentes en verano (37%), el lugar más frecuente es la carretera (47%) y el mecanismo el accidente de tráfico (45%). Ha habido un 15% de éxitus, de los cuales el 75% ocurre en las primeras 24 horas. Existe relación entre trauma abdominal y tipo de mecanismo (p<0,05), siendo el más frecuente el accidente de (..) (AU)

Objective. To present our experience with severe pediatric trauma. The pediatric trauma is the leading cause of death in children under2 years. Methods. We achieved a retrospective study from 78 pediatric patients admitted to the Intensive Care Unit (UCI) for multiple trauma between 2000 and 2008. Age, sex, season, location, mechanism, Glasgow and ITP, type of injuries, complications, days of hospitalization and deaths were reviewed. It was performed descriptive and analytical study using the SPSS 15.0 and chi square and Pearson correlation were applied. Outcomes. The mean age of patients was of 8.5 ± 4.2 years with (..) (AU)

La PEG: ¿Por qué esperar? / The peg: why wait?

La alteración en la deglución constituye un impedimento para la alimentación del paciente. La gastrostomía endoscópica percutánea(PEG) es una buena alternativa a la sonda nasogástrica (SNG) en pacientes que precisan nutrición enteral prolongada debido a problemas enla deglución o falta de medro. Material y métodos. Hemos realizado 40 PEG en nuestro Servicio en los últimos 10 años. Se han recogido datos de edad, peso, indicación, tipos de PEG, tiempo transcurrido hasta el primer cambio, pesoevolutivo y percentiles y complicaciones. Resultados. La edad media de nuestros pacientes fue de 5 años, delos cuales el 30% son menores de 1 año. Se utilizaron en su mayoría (..) (AU)

The swallowing disorder is an impediment to feed the patient. The percutaneous endoscopic gastrostomy (PEG) offers importants advantages over nasogastric tube feeding in patients who need long-term enteral nutrition with difficulty to swallow and to failure to thrive. Methods. We have achieved 40 PEG in our department over the past 10 years. We registered date of the age, weight, indications, types of PEG, the time to first change, evolution of weight and percentiles and the complications. Results. The average age of our patients was 5 years, 30% under1 year. We used mostly tubes between 9 and 15 Fr and increasing the (..) (AU)

Diagnóstico diferencial de las masas interlabiales en niñas menores de 5 años / Differential diagnosis of the interlabial masses in girls under 5 years old

Las masas que podemos encontrar a nivel interlabial en una niña representan un amplio espectro de lesiones heterogéneas y a menudo existe confusión en su diagnóstico, manejo y pronóstico. Material y métodos. Se presentan 5 casos de masas interlabiales, prolapso uretral, dos quistes parauretrales de Skene, sarcoma botrioidevaginal y pólipo fibroepitelial de vagina, y su clínica de debut. Resultados. El prolapso uretral se presenta en una niña de 4 años (..) (AU)

We present 5 cases of interlabial masses, prolapsed urethra, two paraurethral Skene cysts, botryoid sarcoma and fibroepithelial polyp, and its clinical of debut. Results. A prolapsed urethra is presented in a 4 year old black girl with vaginal bleeding from edamatous periurethral mass. The paraurethral cyst is a yellowish cystic mass displacing the urethral meatus in two newborn girls. The fibroepithelial polyp is presented in a newborn girl as polipoid and wart like tumor and not bleeding injury in the introitus. The botryoid sarcoma appears in a 1 year old girl with ulcerated polypoid mass of 2 cm from vagina. All cases were treated with (..) (AU)

[Our experience in the poly-traumatized pediatric patient with criteria for admission to the ICU]. / Nuestra experiencia en el paciente politraumatizado pediátrico con criterios de ingreso en UCI.

OBJECTIVE: To present our experience with severe pediatric trauma. The pediatric trauma is the leading cause of death in children under 2 years. METHODS: We achieved a retrospective study from 78 pediatric patients admitted to the Intensive Care Unit (UCI) for multiple trauma between 2000 and 2008. Age, sex, season, location, mechanism, Glasgow and ITP, type of injuries, complications, days of hospitalization and deaths were reviewed. It was performed descriptive and analytical study using the SPSS 15.0 and chi square and Pearson correlation were applied. OUTCOMES: The mean age of patients was of 8.5 +/- 4.2 years with 70% boys. Most accidents occurred in summer (37%) and the most common site was the road (47%). There was 15% of mortality, which the 75% occurred in the first 24 hours. There is an association between abdominal trauma and type of mechanism (p < 0.05). The most common mechanism was the traffic accident (45%) followed by a direct hit. Both ITP as Glasgow score were associated significantly with mortality and complications and with the hospital stay in the UCI there was a weak association but significant and negative (p < 0.05). CONCLUSIONS: Mortality is higher than other series but it may be because that these series include minor injuries. The fall down is the most frequent in pediatric emergencies but it was the mechanism that involves less admission to the UCI. Both ITP as Glasgow score are good indicators of severity and if their values decrease, the hospital stay in UCI and the mortality increase.

[Our experience with the use of alpha-lithic therapy in the treatment of voiding dysfunction]. / Nuestra experiencia con el uso de alfa-líticos en el tratamiento de la disfunción de vaciado.

INTRODUCTION: Dysfunctional voiding (DV) is due to a dysfunction in the pelvis floor muscles caused by hyperactivity of the urethral sphincter and the musculature of this zone during the voiding phase of the micturition cycle. The treatments used are recommending correct micturition habits, biofeedback and pelvic relaxation exercises. Currently, drugs are also used, such as alpha lithic drugs and injection of botulinic toxin, however its experience in children is limited. OBJECTIVES: Show our experience with the use of alpha-lithics in patients with DV. MATERIAL AND METHODS: Review of patients with DV treated with alpha-lithics in our institution. RESULTS: 6 patients with DV were treated with alpha-lithics (Alfuzosin or Doxazosin). Girl (12 years) with Wolfram Syndrome with significant post-void residual urine, who initially rejected intermittent catéter. Residual urine decreases slightly with treatment, but isn't enough. Boy (7 years) with uretral duplicity and difficulty urine flow without observable stenosis. He had initial improvement but then required continent bladder diversión and vasectomy due to recurrent orchiepididymitis. Boy (5 years) with ureteral-bladder stenosis and ureteral reimplantation with urinary tract infection and vesico-ureteral reflux that did not improve (an anatomic obstruction was subsequently found). Boy (12 years) with tethered cord and pyelonephritis, who rejected intermittent catheter. He hadn't improvement and he required continent bladder diversión. Boy (7 years) with Syringomyelia, operated in another center for vesico-ureteral reflux with ureteral reimplantation, with recurrent urine infections, who hadn't improvement and required continent bladder diversion. Boy (10 years) with resected urethra valves and normal cystoscopy, with episodes of urine retention, without improvement with treatment. CONCLUSION: The role of alpha-lithics in the treatment of dysfunctional voiding in children is limited and of doubtful efficacy. It may be useful in patients with significant post-micturition residue.

[Proposal for a new microsurgical model for the study of induced endometriosis in Wistar rats. Preliminary results]. / Propuesta de un nuevo modelo microquirúrgico para el estudio de la endometriosis inducida en rata Wistar. Resultados preliminares.

The current knowledge status on the patogenesis of endometriosis as well as devastating consequences of disease evolution in women's reproductive health, have promoted researchers advances in a great manner during last years. The immunologic and neangiogenesis systems implication have opened new ways of knowledge over classic theories from the beginning of the xx century. The experimental resesearch, using animal induction models. Below we explain the first steps a new induction model ("PGR1-HotDog"), based on Wistar rats using a new disease autogeneration system, created for te study of the early stages of the endometriosis.