Surgical treatment for necrotizing enterocolitis: a new score to extreme surveillance.

BACKGROUND: The time to perform a surgical intervention in necrotizing enterocolitis remains a challenge for the pediatric surgeon. We design a novel score system to predict infants in high risk for the development of surgical necrotizing enterocolitis. METHODS: A total of 124 consecutively patients diagnosed of NEC at the University Hospital of A Coruña, Spain were included in the study. Associations were analyzed by bivariate and multivariate analysis. We applied multivariate logistic regression modeling to identify factors that could provide accurate risk of surgical NEC. We include not only analytical and radiological parameters or physical examination, but we also analyzed prenatal, sociodemographic, perinatal and peripartum variables that conditioned the presence of predispose factors, which could determine the debut of this entity and in its progression. RESULTS: Patients requiring surgical treatment have presented an antecedent of respiratory distress (worsening of the ventilatory requirements) in the perinatal period, they present higher values of glycemia at diagnosis of the illness, debut with coagulopathy and have in laboratory findings marked neutrophilia. CONCLUSIONS: Our score system obtained by combining several parameters could detect infants at risk of developing severe necrotizing enterocolitis improving the morbidity and mortality associated with delay in the surgical treatment.

Distal Urethral Advance and Glanduloplasty (DUAGPI) for Distal Hypospadias: A 15 Years Experience.

BACKGROUND: Meatal advancement with glanduloplasty (MAGPI) has been in the recent years one of the most frequently surgical techniques used for the correction of distal hypospadias. Multiple modifications have been described to improve the results ofthis technique. In 2004 we presented the initial results of the New Modern MAGPI or DUAGPI (distal urethral advancement and glanduloplasty) as a surgical alternative to the original MAGPI. OBJETIVE: The objective of the present study is to evaluate the applicability, safety and the cosmetic results obtained with this technique, as well as the long-term complications. MATERIALS AND METHODS: Retrospective and descriptive study of patients with distal hypospadias, corrected using the DUAPI technique, between 2002 and 2018. SURGICAL TECHNIQUE: Initially, an artificial erection was performed, the absence of curvature in all patients is proven. A skin denudation was performed up to the base of the penis in those children with a bend greater than 30. Second, the distal urethral disconnection was performed at the posterior and lateral urethral level. A glandular triangular section is made to accommodate the distal urethra and to allow a conical appearance with a final glandular. Finally, the fixation of the distal urethral to the glandular tip and the anterior glandular closure is performed. We performed an annual follow-up of all patients. The analysis of all the variables collected during surgery and follow-up was done with SPSS 22 statistical package. RESULTS: 90 patients meet inclusion criteria and were included in the study (32 glandular and 58 coronal). The mean surgical time was 47 minutes (Range: 37-71 minutes). The mean follow-up was 9.4 years (2.1-15 years). 2 patients had meatal stenosis after surgery, 4 mild glandular retraction, and 2 urethrocutaneous fistula. Six of the 8 patients with a complication were successfully reoperated. 92% of the patients and their families were satisfied with the cosmetic result obtained after surgery (83 patients). CONCLUSION: DUAGPI technique is simple, reproducible and optimal for most distal hypospadias. It is a safe technique, with a low complication rate. The final aesthetic result is satisfactory in most cases, with a conical glans and a natural cosmetic appearance.

[Commentary on Symptoms severity profile and expectations in hyperactive bladder patients. VHEXPECTA Study.] / Comentario sobre perfil de severidad sintomática y expectativas en pacientes con vejiga hiperactiva. Estudio VHEXPECTA.

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Julio de 2020, por Castro-Díaz et al., titulado "Perfil de severidad sintomática y expectativas en pacientes con vejiga hiperactiva. Estudio VHEXPECTA" (1), y que hemos leído con gran interés. A propósito de este trabajo creemos conveniente ampliar la información ofrecida por sus autores, y plantear una serie de consideraciones por nuestra parte.

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Julio de2020, por Castro-Díaz et al., titulado "Perfil de severidad sintomática y expectativas en pacientes convejiga hiperactiva. Estudio VHEXPECTA" (1), y que hemos leído con gran interés. A propósito de estetrabajo creemos conveniente ampliar la información ofrecida por sus autores, y plantear una serie deconsideraciones por nuestra parte.

Update on sacral neuromodulation and overactive bladder in pediatrics: A systematic review. / Puesta al día en neuromodulación y vejiga hiperactiva en pediatría: una revisión sistemática.

OBJECTIVES: Sacral electrical stimulation has been used for more than a century as an alternative therapy for adult urinary syndromes. In the literature, several studies have validated the efficacy of this technique based on clinical and urodynamic criteria. Nevertheless, few studies have shown beneficial results in children with overactive bladder. MATERIAL AND METHODS: We performed a systematic review of studies assessing the impact of sacral electroestimulation treatment on overactive bladder in children. The search identified 389 potentially eligible items. Of them, 14 studies published between 2001and 2019 met the study criteria and were selected for systematic review. RESULTS: All of papers included in this review individually demonstrated a high efficiency rate with good shortterm results, as well as safety in its use due to its minimalrate of adverse effects. However, the comparison of the results obtained in all of them was not possible because the high variety and heterogeneity in the different studies. The main limitation is that there is still no standard protocol for the application of this therapy in the pediatric population. CONCLUSION: This review revealed the promising benefits of sacral electroneuromodulation in pediatric patients with overactive bladder. However, more studies with strictly meet pediatric overactive bladder diagnosis and management criteria should be done to protocolize and clarify the effectiveness of this therapeutic approach.

OBJETIVO: La estimulación eléctrica a nivel sacro ha sido usada durante más de un siglo como una alternativa terapéutica más en el manejo de los síndromes urinarios entre la población adulta. A lo largo de la literatura múltiples estudios han corroborado la eficacia de esta técnica, basándose en resultados clínicos y criterios urodinámicos. Sin embargo, son escasos los estudios que analizan los potenciales beneficios de esta modalidad terapéutica en niños con vejiga hiperactiva.MATERIAL Y MÉTODOS: Realizamos una revisión sistemática de los estudios que analizan el impacto de la electroestimulación nerviosa sacra en el tratamiento de la vejiga hiperactiva en pediatría. La búsqueda identificó 389 trabajos potencialmente elegibles. De entre todos ellos, 14 estudios publicados entre 2001 y 2019 reunieron los criterios adecuados para ser seleccionados y formaron parte de la presente revisión sistemática. RESULTADOS: Todos los estudios incluidos en esta revisión demostraron de forma individual la alta eficacia y unos buenos resultados a corto plazo con esta terapia, así como su seguridad, dada la baja tasa de efectos adversos de la misma. Sin embargo, la comparación de estos resultados en todos estos estudios no fue posible, debido a la gran variedad y heterogeneidad en la metodología y la forma de expresión de los resultados entre todos ellos. El motivo que genera esta gran diversidad de resultados entre los diferentes trabajos incluidos en esta revisión es la falta de un protocolo estándar para la aplicación de esta terapia en la población pediátrica.CONCLUSIÓN: En conclusión, esta revisión revela los prometedores beneficios de la electroterapia nerviosaa nivel sacro en los pacientes pediátricos con vejiga hiperactiva. Sin embargo, es necesario realizar más estudios que analicen los efectos de este tratamiento. La metodología de los mismos deberá ser estricta, con unos criterios estandarizados sobre la inclusión de los pacientes, el diagnóstico de vejiga hiperactiva, y la medición de la eficacia obtenida. Así, será posible realizar protocolos de aplicación de esta modalidad terapéutica, y sus efectos podrán ser esclarecidos.

Update on sacral neuromodulation and overactive bladder in pediatrics: a systematic review / Actualización en neuromodulación sacra y vejiga hiperactiva en pediatría: una revisión sistemática

Objetives: Sacral electrical stimulationhas been used for more than a century as an alternativetherapy for adult urinary syndromes. In the literature, several studies have validated the efficacy of this techniquebased on clinical and urodynamic criteria. Nevertheless,few studies have shown beneficial results in children withoveractive bladder.Material and methods: We performed a systematic review of studies assessing the impact of sacralelectroestimulation treatment on overactive bladder inchildren. The search identified 389 potentially eligibleitems. Of them, 14 studies published between 2001and 2019 met the study criteria and were selected forsystematic review. Results: All of papers included in this review individually demonstrated a high efficiency rate with good shortterm results, as well as safety in its use due to its minimalrate of adverse effects. However, the comparison of theresults obtained in all of them was not possible becausethe high variety and heterogeneity in the different studies. The main limitation is that there is still no standardprotocol for the application of this therapy in the pediatric population.Conclusions: This review revealed the promisingbenefits of sacral electroneuromodulation in pediatricpatients with overactive bladder. However, more studieswith strictly meet pediatric overactive bladder diagnosisand management criteria should be done to protocolizeand clarify the effectiveness of this therapeutic approach.(AU)

Objetivos: La estimulación eléctrica a nivel sacro ha sido usada durante más de un siglo comouna alternativa terapéutica más en el manejo de los síndromes urinarios entre la población adulta. A lo largode la literatura múltiples estudios han corroborado la eficacia de esta técnica, basándose en resultados clínicosy criterios urodinámicos. Sin embargo, son escasos losestudios que analizan los potenciales beneficios de estamodalidad terapéutica en niños con vejiga hiperactiva.Material y métodos: Realizamos una revisión sistemática de los estudios que analizan el impacto de laelectroestimulación nerviosa sacra en el tratamiento de a vejiga hiperactiva en pediatría. La búsqueda identi-ficó 389 trabajos potencialmente elegibles. De entretodos ellos, 14 estudios publicados entre 2001 y 2019reunieron los criterios adecuados para ser seleccionados y formaron parte de la presente revisión sistemática.Resultados: Todos los estudios incluidos en esta revisión demostraron de forma individual la alta eficacia yunos buenos resultados a corto plazo con esta terapia,así como su seguridad, dada la baja tasa de efectosadversos de la misma. Sin embargo, la comparaciónde estos resultados en todos estos estudios no fue posible, debido a la gran variedad y heterogeneidad en lametodología y la forma de expresión de los resultadosentre todos ellos. El motivo que genera esta gran diversidad de resultados entre los diferentes trabajos incluidosen esta revisión es la falta de un protocolo estándarpara la aplicación de esta terapia en la población pediátrica.Conclusion: En conclusión, esta revisión revela losprometedores beneficios de la electroterapia nerviosaa nivel sacro en los pacientes pediátricos con vejigahiperactiva. Sin embargo, es necesario realizar másestudios que analicen los efectos de este tratamiento.La metodología de los mismos deberá ser estricta, conunos criterios estandarizados sobre la inclusión de los...(AU)

Transcutaneous sacral electrical stimulation versus oxibutynin for the treatment of overactive bladder in children.

BACKGROUND: Nowadays there is still no ideal treatment for paediatric overactive bladder. Initial management measures (urotherapy and constipation control), resolve 40% of cases. The second line of treatment in overactive bladder is anticholinergic drugs, above all oxybutynin. Although most patients improve with these therapies, the complete resolution rate is around 30-40%. Sacral transcutaneous electrical nerve stimulation has recently emerged as a new alternative in the management of patients with refractory paediatric overactive bladder. However, only a few studies have been done to compare the effectiveness of this therapy versus conventional drugs. OBJETIVE: The objective of the present study is to compare, in children with overactive bladder, the efficacy of the sacral transcutaneous electrical nerve stimulation versus oxybutynin therapy. MATERIALS AND METHODS: We performed a prospective and randomized study of patients with diagnosis of overactive bladder treated with sacral transcutaneous electrical nerve stimulation versus oxybutynin, during the period July 2018-July 2020. Patients refractory to standard urotherapy and constipation management randomly received one of the therapeutic alternatives. Treatment was maintained for 6 months. RESULTS: 86 patients were included in the study: 40 patients received electrotherapy (group 1) and 46 patients received oxybutynin (group 2). Before starting the treatment assigned both groups were comparable related to the voiding symptomatology as well as the severity of the overactive bladder. Sacral transcutaneous electrical nerve stimulation was significantly more effective than oxybutynin, with a higher percentage of complete resolution of symptoms in the management of paediatric overactive bladder. VOIDING DIARY: All the parameters obtained with the voiding calendar significantly improved in both groups at the end of the treatment. The increase in MaVV was significantly higher in group-1. DVISS (DYSFUNCTIONAL VOIDING AND INCONTINENCE SCORING SYSTEM): We observed a progressive decrease in the mean score obtained in the DVISS questionnaire over time in both groups. This decrease was significantly higher in group-1 compared to group-2 (p < 0.005). The mean value obtained in the DVISS questionnaire in group-1 was 6 (interquartile range: 3-9) at the end of the treatment (lower than the diagnostic cut-off point for daytime condition in the DVISS, 8.5). In group-2, the mean value obtained in the DVISS questionnaire was 10 (interquartile range: 8.75-13.25), higher than the cut-off point. COMPLICATIONS: A greater number of adverse effects was obtained in group-2 (26.1% versus 15%, p < 0.05). Constipation (n: 6, 10.9%), and abdominal pain (n: 2,4.3%) were the most frequent adverse effects in this group. The adverse events reported in group-1 were contact dermatitis (n: 1.2%) and fecal losses [2] or urgency [5]. CONCLUSION: Oxybutynin and sacral transcutaneous electrical nerve stimulation are both effective therapies in the management of paediatric overactive bladder. However, electrotherapy has been shown to be a more effective therapy with a complete clinical resolution rate in a larger number of patients. Furthermore, the rate of adverse effects secondary to electrotherapy is significantly lower than those treated with oxybutynin.

Granuloma piogénico: masa testicular indolora en un niño / Pyogenic granuloma: Painless scrotal mass in a child

No disponible

Acalasia cricofaríngea primaria / Primary cricopharyngeal acalasia

No disponible

Dermal regeneration sheet Integra® in management of recurrent Urethrocutaneous fistula after hypospadias surgery.

BACKGROUND: Urethrocutaneous fistula UCF is the most common complication following surgical repair of hypospadias. Currently, the surgical technique mostly used to prevent recurrence employs preputial dartos or testicular tunica vaginalis flaps as a urethral covering. However, autologous tissues are limited in patients with multiple surgeries, and the use of biomaterials as a urethral coverage may represent a good alternative. OBJECTIVE: The goal of the present study is to assess the results and complications of recurrent UCF correction using a dermal bovine regeneration sheet as a urethral covering. MATERIALS AND METHOD: From May 2016 to January 2019, all patients with recurrent UCF of the authors center were repaired using this technique. The inclusion criteria were patients who had undergone one or more unsuccessful UCF repair surgeries and the absence of preputial tissue. The informed consent has been signed by all the patients. Patients were examined in outpatient consultations where their urinary stream was evaluated and a physical examination of the penis was conducted. RESULTS: A total of 12 patients and 13 UCFs were included in the study. The median follow-up was 18 months, (range: 4-26), and only two patients (15%) developed a recurrence of UCF. No complications were observed in the remaining patients (85%) during their evolution. No patient developed a fibrosis increase or loss of elasticity of the tissues in contact with the dermal matrix. CONCLUSION: The use of an Integra® sheet as a urethral covering during urethral fistula surgery appears to be a safe, effective, and easily reproducible option. However, prospective studies with larger numbers of patients should be performed to corroborate these results.

Lámina artificial Integra(R) como cobertura uretral durante la cirugía de secuela de hipospadias / Integra(TM) artificial sheet as urethral covering during surgery for hypospadias sequel

No disponible

[Integra™ artificial sheet as urethral covering during surgery for hypospadias sequel.] / Lámina artificial Integra® como cobertura uretral durante la cirugía de secuela de hipospadias.

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Diciembre de 2017, por Tardáguila Calvo et al., titulado "Reconstrucción genital con dermis artificial Integra® tras resección radical en un niño con linfangiomatosis difusa" (1), y que hemos leído con gran interés. A propósito de este trabajo creemos conveniente ampliar la información de los autores compartiendo nuestra experiencia previa (2,3).

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Diciembre de 2017, por Tardáguila Calvo et al., titulado "Reconstrucción genital con dermis artificial Integra® tras resección radical en un niño con linfangiomatosis difusa" (1), y que hemos leído con gran interés. A propósito de este trabajo creemos conveniente ampliar la información de los autores compartiendo nuestra experiencia previa (2,3).

[Comparative analysis of the treatment of mid-shaft and distal hypospadias according to Snodgrass surgical repair and Mathieu technique.] / Reparación quirúrgica de los hipospadias medios y distales: análisis comparativo entre la técnica de Snodgrass versus técnica de Mathieu.

OBJECTIVE: The objective of this study is to perform an analysis of the patients who underwent middle and distal penile hypospadias repair using the two most widely used techniques in our Pediatric Urology Unit. MATERIAL AND METHODS: We perform a retrospective analysis of patients with a diagnosis of middle penile and distal penile hypospadias and operated by the Snodgrass or Mathieu technique, between 2011 and 2016 ensuring minimal follow-up of one year. We will analyze the use of each one, the results obtained, and the possible factors that could influence their success rate. RESULTS: A total of 80 patients were included in the study, with a median age of 28 months at surgery (Range: 11 to 151). There were 34 patients (42.5%) with Snodgrass technique and there were 46 patients (57.5%) with Mathieu technique. We have not identified statistically significant differences in complications between both surgical techniques. The percentage of fistulas is higher in Snodgrass urethroplasty (12.1% vs 8.9%), decreasing in the last years of the series, at the same time meatal stenosis is higher in Snodgrass technique (3% vs 2.2%) while the meatal retraction is higher in the urethroplasty of Mathieu (20% vs 15.2%). CONCLUSIONS: The exhaustive selection of patients seems the key in the succesful correction of these types of hypospadias. Despite both techniques are comparable in terms of the type of patient in which they could be applied and both techniques present similar rates in terms of fistulas and stenosis/retractions of the neomeatus (most frequent complications in this type of repairs), we consider that the characteristics of the patient should be prioritized before the preference of the surgeon to reach higher success rates.

OBJETIVO: El objetivo de este estudio es realizar un análisis de los pacientes intervenidos de hipospadias peneanos medios y distales mediante la realización de las dos técnicas más ampliamente utilizadas en nuestra unidad de Urología Pediátrica: técnica de Mathieu versus técnica de Snodgrass. MATERIAL Y MÉTODOS: En este trabajo se realiza un análisis retrospectivo de los pacientes con diagnóstico de hipospadias peneano medio y peneano distal, intervenidos mediante la técnica de Snodgrass o técnica de Mathieu, entre los años 2011 y 2016. El seguimiento mínimo de los pacientes, para formar parte de este estudio, fue de 1 año. Analizamos la tasa de empleo de cada técnica quirúrgica, los resultados obtenidos con cada una de ellas, y los factores que podrían influir en la tasa de éxito de las mismas. RESULTADOS: Un total de 80 pacientes fueron incluidos en el estudio. El 42,5% (34 pacientes) fueron intervenidos según la técnica de Snodgrass y el 57,5% (46 pacientes) según la técnica de Mathieu. La edad media de los pacientes en el momento de la intervención fue de 28 meses (Rango: 11-151). No existieron diferencias estadísticamente significativas entre las complicaciones de ambas técnicas quirúrgicas. El porcentaje de fístulas fue más elevado en la uretroplastia de Snodgrass (12,1% vs 8,9%). Esta complicación sufrió una disminución progresiva en los últimos años de la serie. Así mismo la estenosis meatal también fue más frecuente en la técnica de Snodgrass (3% vs 2,2%) mientras que la retracción meatal se presenta más frecuentemente tras una corrección según técnica de Mathieu (20% vs 15,2%). CONCLUSIONES: A pesar de ser técnicas comparables en cuanto a indicación, resultados y complicaciones presentando tasas similares en cuanto a fistulas y estenosis/ retracciones del neomeato (complicaciones por excelencia en este tipo de reparaciones), la selección de pacientes según las características del pene, debe ser prioritaria sobre la preferencia del cirujano.

Reparación quirúrgica de los hipospadias medios y distales: análisis comparativo entre la técnica de Snodgrass versus técnica de Mathieu / Comparative analysis of the treatment of mid-shaft and distal hypospadias according to Snodgrass surgical repair and Mathieu technique

Objetivo: El objetivo de este estudio es realizar un análisis de los pacientes intervenidos de hipospadias peneanos medios y distales mediante la realización de las dos técnicas más ampliamente utilizadas en nuestra unidad de Urología Pediátrica: técnica de Mathieu versus técnica de Snodgrass. Material y métodos: En este trabajo se realiza un análisis retrospectivo de los pacientes con diagnóstico de hipospadias peneano medio y peneano distal, intervenidos mediante la técnica de Snodgrass o técnica de Mathieu, entre los años 2011 y 2016. El seguimiento mínimo de los pacientes, para formar parte de este estudio, fue de 1 año. Analizamos la tasa de empleo de cada técnica quirúrgica, los resultados obtenidos con cada una de ellas, y los factores que podrían influir en la tasa de éxito de las mismas. Resultados: Un total de 80 pacientes fueron incluidos en el estudio. El 42,5% (34 pacientes) fueron intervenidos según la técnica de Snodgrass y el 57,5% (46 pacientes) según la técnica de Mathieu. La edad media de los pacientes en el momento de la intervención fue de 28 meses (Rango: 11-151). No existieron diferencias estadísticamente significativas entre las complicaciones de ambas técnicas quirúrgicas. El porcentaje de fístulas fue más elevado en la uretroplastia de Snodgrass (12,1% vs 8,9%). Esta complicación sufrió una disminución progresiva en los últimos años de la serie. Así mismo la estenosis meatal también fue más frecuente en la técnica de Snodgrass (3% vs 2,2%) mientras que la retracción meatal se presenta más frecuentemente tras una corrección según técnica de Mathieu (20% vs 15,2%). Conclusiones: A pesar de ser técnicas comparables en cuanto a indicación, resultados y complicaciones presentando tasas similares en cuanto a fistulas y estenosis/ retracciones del neomeato (complicaciones por excelencia en este tipo de reparaciones), la selección de pacientes según las características del pene, debe ser prioritaria sobre la preferencia del cirujano

Objective: The objective of this study is to perform an analysis of the patients who underwent middle and distal penile hypospadias repair using the two most widely used techniques in our Pediatric Urology Unit. Material and methods: We perform a retrospective analysis of patients with a diagnosis of middle penile and distal penile hypospadias and operated by the Snodgrass or Mathieu technique, between 2011 and 2016 ensuring minimal follow-up of one year. We will analyze the use of each one, the results obtained, and the possible factors that could influence their success rate. Results: A total of 80 patients were included in the study, with a median age of 28 months at surgery (Range: 11 to 151). There were 34 patients (42.5%) with Snodgrass technique and there were 46 patients (57.5%) with Mathieu technique. We have not identified statistically significant differences in complications between both surgical techniques. The percentage of fistulas is higher in Snodgrass urethroplasty (12.1% vs 8.9%), decreasing in the last years of the series, at the same time meatal stenosis is higher in Snodgrass technique (3% vs 2.2%) while the meatal retraction is higher in the urethroplasty of Mathieu (20% vs 15.2%). Conclusions: The exhaustive selection of patients seems the key in the succesful correction of these types of hypospadias. Despite both techniques are comparable in terms of the type of patient in which they could be applied and both techniques present similar rates in terms of fistulas and stenosis/retractions of the neomeatus (most frequent complications in this type of repairs), we consider that the characteristics of the patient should be prioritized before the preference of the surgeon to reach higher success rates