Extrofia vesical y vejiga rectal / No disponible

No disponible

Urinoma secondary to ureteropelvic junction obstruction in the neonate. Presentation of a case and bibliographic review.

OBJECTIVE: To analyze the management of prenatal urinoma and ureteropelvic junction obstruction (UPJO) postnatally by a case report and literature review. METHODS: We report a case of an UPJO and urinoma in a newborn. After birth, renal function was absent, and nephrectomy was performed. The literature from 1985 to date has been reviewed. DISCUSSION: By the analysis of the literature, we can observe mainly, that prenatally diagnosed urinoma and UPJO are managed conservatively. After birth, different attitudes have been carried out, independently of residual renal function, such as radical or reconstructive surgery, or conservative treatment. CONCLUSION: Intrauterine management is not indicated. Urinary diversion is indicated in symptomatic cases secondary to renal trauma or endoscopic procedure. In non-functional kidney, nephrectomy is indicated.

Urinoma secundario a estenosis de la unión pieloureteral en el neonato. Presentación de un caso y revisión de la literatura / Urinoma secondary to ureteropelvic junction obstruction in the neonate. Presentation of a case and bibliographic review

OBJETIVO: Analizar el manejo del urinoma prenatal y de la estenosis de la unión pieloureteral postnatalmente mediante el estudio de un caso y revisión bibliográfica. MÉTODOS: Se presenta el caso de neonato con EUPU y urinoma. Se comprueba función renal anulada, realizándose nefrectomía. Se ha revisado la literatura desde 1985 hasta la actualidad. DISCUSIÓN: Analizando la literatura, se observa mayoritariamente que el tratamiento de la EUPU y urinoma prenatales es conservador. Tras el nacimiento existen diversas actitudes, independientemente de la función renal remanente, como son la cirugía radical, la reconstructiva o el tratamiento conservador. CONCLUSIONES: La manipulación intraútero no está indicada sistemáticamente. La derivación urinaria sólo en casos sintomáticos y los secundarios a traumatismo o manipulación endoscópica. En riñones anulados estaría indicada la nefrectomía (AU)

OBJECTIVE: To analyze the management of prenatal urinoma and Ureteropelvic Junction Obstruction (UPJO) postnatally by a case report and literature review. METHODS: We report a case of an UPJO and urinoma in a newborn. After birth, renal function was absent, and nephrectomy was performed. The literature from 1985 to date has been reviewed. DISCUSSION: By the analysis of the literature, we can observe mainly, that prenatally diagnosed urinoma and UPJO are managed conservatively. After birth, different attitudes have been carried out, independently of residual renal function, such as radical or reconstructive surgery, or conservative treatment. CONCLUSION: Intrauterine management is not indicated. Urinary diversion is indicated in symptomatic cases secondary to renal trauma or endoscopic procedure. In non-functional kidney, nephrectomy is indicated (AU)

Tratamiento conservador de un absceso renal múltiple / Successful conservative management of a multiple renal abscess in a child

Los abscesos renales son poco frecuentes en niños, pero sus consecuencias pueden ser graves, incluyendo sepsis, daños renales graves o la pérdida del riñón. Describimos el caso de una paciente de tres años de edad, diagnosticada de un absceso múltiple en el riñón izquierdo tras un episodio febril. El caso presenta interés debido a la rara forma de presentación de una infección del tracto urinario como absceso renal múltiple, al tamaño y localización diseminada de las lesiones (cuatro abscesos en un riñón) y al tipo de tratamiento realizado, que consistió en antibióticos intravenosos con el fin de preservar el parénquima renal (AU)

Renal abscesses are uncommon in children but their consequences could be serious, including sepsis, severe renal damage or loss of the kidney. The following report describes a three-year-old girl diagnosed of multiple renal abscess in the left kidney after a first episode of fever. The case is significant due to the uncommon presentation of a urinary tract infection as a multiple abscess, the extension of the injuries (there were 4 abscesses in the kidney) and the conservative therapy with intravenous antibiotics which was selected in order to preserve renal tissue (AU)

[Successful conservative management of a multiple renal abscess in a child]. / Tratamiento conservador de un absceso renal múltiple.

Renal abscesses are uncommon in children but their consequences could be serious, including sepsis, severe renal damage or loss of the kidney. The following report describes a three-year-old girl diagnosed of multiple renal abscess in the left kidney after a first episode of fever. The case is significant due to the uncommon presentation of a urinary tract infection as a multiple abscess, the extension of the injuries (there were 4 abscesses in the kidney) and the conservative therapy with intravenous antibiotics which was selected in order to preserve renal tissue.

Hipospadias / Hypospadias

El hipospadias es la malformación congénita más frecuente de la uretra. Es una alteración de etología desconocida aunque en los últimos años se han identificado posibles factores de riesgo y predisponentes, como los genéticos, hormonales o farmacológicos. Es importante el diagnóstico temprano; en la primera visita la información a los padres es fundamental, explicando el plan a seguir, los objetivos, el tipo de intervención y las posibles complicaciones. Se descartarán anomalías urológicas que pueden estar asociadas como criptorquidia, hernia inguinal o alteraciones en el tracto urinario superior. No existe consenso sobre la edad más adecuada de corrección, pero se recomienda realizarla en la edad preescolar. Con el fin de facilitar la intervención quirúrgica puede administrarse previamente tratamiento hormonal. Los objetivos de la corrección quirúrgica son conseguir un pene sin incurvaciones, una función miccional y reproductiva adecuada y el mejor resultado estético posible. Existen múltiples técnicas quirúrgicas, siendo necesario dominar las más utilizadas, ya que no existen dos casos iguales y cada uno precisa una técnica concreta, sobre todo en reintervenciones. ES frecuente la aparición de complicaciones postquirúrgicas, como fístulas o estenosis uretrales que obliguen a la reintervención (AU)

Hypospadias is the most common congenital malformation of the urethra. The ethiology is unknown, but recently several studies have identified some risk factors like genetic, hormonal or pharmacological factors. Early diagnosis is important; In the first clinic visits the information is essential for parents, explaining the action plan, objectives, type of surgery and most frequent complications. Associated urological abnormalities like cryptorchidism, inguinal hernia or alterations in upper urinary tract should be diagnosed, There is no consensus on the appropriate age at surgery, but we recommended performing it before the start of the school. In order to facilitate surgical intervention may be given hormonal therapy. The objetives of surgical correction are gettinga penis with-out incurvations, normal urinary and reproductive function and obtain a good cosmetic result. There are several surgical techniques and we need to know the most used, because each case requires a specific technique, especially in reoperations. Postoperative complications are common. The most frequent complications are fistula and urethral stricture and they require reoperation (AU)

Is a third endoscopic treatment for vesicoureteral reflux indicated if previous attempts have failed?

OBJECTIVE: To evaluate the efficacy of a third endoscopic injection to correct vesicoureteral reflux (VUR). PATIENTS AND METHODS: This was a prospective study of 605 patients, of whom 42 (6.4%), involving 44 (4%) ureteral units, received a third injection. The results were analysed regarding VUR grade and aetiology, substance used, volume, location and morphology of the mound, presence of poor prognostic factors, the urologist's experience, and complications. RESULTS: The treatment resolved the VUR in 38 (86.4%) units, 22 of primary cause (91.6%) and 16 with anatomical/functional abnormalities (80%) (no significant difference; P = 0.26). There was also no significant difference in success rate with regard to the substance injected (P = 0.23), the degree of VUR (P = 0.76) or the volume injected (P = 0.17). The success rate was higher (96.9%) if a less experienced urologist had performed the previous procedure versus a more experienced urologist (54.5%), and this difference was significant (P < 0.005). There was one complication (haematuria) (2.3%). CONCLUSION: Third treatment presents a similar efficacy to first and second treatments, with a very low rate of complications, and could be indicated before open surgery.

[Urethral polyposis in adolescence]. / Poliposis ureteral en la adolescencia.

Polyps in the urinary tract are a rare entity in infants and children. The most frequent location when they appear is the ureter. These benign lesions with no malignant potential have a varied form of presentation and in most cases must be distinguished from malignancy. The suspected diagnosis is due to urinary obstruction; nevertheless radiological evidence played a key role in the final diagnosis. The management is as less invasive as possible, with endoscopy resection or minimally invasive surgery.

[Congenital fibroepithelial polyps of the urethra]. / Pólipos fibroepiteliales congénitos de uretra.

Urethral polyps are a rare pathology that is usually diagnosed in childhood hematuria and obstructive urinary symptoms are the most common findings and transurethral resection is the best choice of the treatment. We report three cases, a 6-years-old boy and 9-years-old boy diagnosed and treated of posterior urethral polyp after showing hematuria and obstructive urinary symptoms, and a 2-years-old girl that showed to prolapse of urethral polyp.

Pólipos fibroepiteliales congénitos de uretra / Congenital fibroepithelial polyps of the urethra

Los pólipos fibroepiteliales de uretra comprenden una patología infrecuente, suelen ser diagnosticados en edad pediátrica por hematuria o síndrome obstructivo bajo y requieren tratamiento quirúrgico para su resolución. Presentamos tres casos clínicos, dos varones de seis y nueve años que fueron diagnosticados y tratados de esta patología tras presentar un cuadro de hematuria franca y dificultad miccional, y una niña de dos años que debutó con clínica de prolapso de masa polipoide por uretra (AU)

Urethral polyps are a rare pathology that is usually diagnosed in childhood hematuria and obstructive urinary symptoms are the most common findings and transurethral resection is the best choice of the treatment .We report three cases, a 6-years-old boy and 9-years-old boy diagnosed and treated of posterior urethral polyp after showing hematuria and obstructive urinary symptoms, and a 2-years-old girl that showed to prolapse of urethral polyp (AU)

[Hypospadias repair with Snodgrass' technique]. / Reparación de hipospadias mediante la Técnica de Snodgrass.

Retrospective study of 124 patients (average age: 3.8 years) with midpenile hypospadias: 48.3% (60 children), distal penile: 45.9% (57) and coronal 5.6% (7), of which the 25.8% (16) presented ventral curvature and the 4.8% (6) resulting from the complication of another previous technique. All of them were operated according to Snodgrass' technique, removing the catheter between the 6th and 7th day in most of them. The global rate of complications was of 12%: 9 fistulae (7.2%) and 6 meatal stenosis (4.8%). Aesthetic result was satisfactory in all cases, getting glans covered by foreskin in 57.3%.

Reparación de hipospadias mediante la Técnica de Snodgrass / Hypospadias repair with Snodgrass´Technique

Estudio retrospectivo de 124 pacientes (edad media: 3,8 años) con hipospadias peneano medio: 48,3% (60 niños), peneano distal: 45,9% (57) y coronal 5,6% (7), de los cuales el 25,8% (16) presentaban incurvación ventral y el 4,8% (6) procedían del fracaso de otra técnica. Todos ellos intervenidos según técnica de Snodgrass, retirando la sonda entre el 6 y 7º día en la mayoría. La tasa global de complicaciones fue del 12%: 9 fístulas (7,2%) y 6 estenosis de meato (4,8%). El resultado estético fue satisfactorio en todos los casos, quedando incluso el glande cubierto por prepucio el 57,3%

Retrospective study of 124 patients (average age: 3.8 years) with midpenile hypospadias: 48,3% (60 children), distal penile: 45,9% (57) and coronal 5,6% (7), of which the 25.8% (16) presented ventral curvature and the 4,8% (6) resulting from the complication of another previous technique. All of them were operated according to Snodgrass´ technique, removing the catheter between the 6th and 7th day in most of them. The global rate of complications was of 12%: 9 fistulae (7,2%) and 6 meatal stenosis (4,8%). Aesthetic result was satisfactory in all cases, getting glans covered by foreskin in 57,3%

[Assesmment urethrorrhagia in childhood]. / Valoración de la uretrorragia en el niño.

OBJECTIVE: [corrected] To review urethrorrhagia cases, the need of complementary test, its management and natural history. MATERIAL AND METHOD: A retrospective analysis was carried out for the 12 patients who suffered from urethrorrhagia, consecutively diagnosed in our department. Parameters as age, and micturitional habit were evaluated. In this way, we described the diagnostic techniques used, assessment and the follow-up of each patient. RESULTS: All cases correspond to male children with an average age of 8.7 years (range: 18 months-14 years). Urethrorrhagia appears in 100% of the patients, episodes which were daily in 58.4%. 33% (4/12) of them also present other micturitional symptoms. 75% (9/12) had a lazy micturitional habit. Among the urological backgrounds we found: 1 patient was circumcised 3 years ago, a meatotomy was done in other due to meatus stenosis 2 years before, and a last one had an electrocoagulation of a urethral polyp just 1 month before. 83.4% (10/12) of urine cultures were negative. An urethrocystoscope was done in 9 patients finding a verum hypertrophy in 4, inflammatory changes next to membranous urethra in 3, scar at the bulbar urethra in 1 and in a last one no abnormalities were found. Out of 8 patients with lazy micturitional habit, 75% (6/8) resolve spontaneously once they correct their habits after a mean follow-up of 9 months. Only 2 patients needed surgery (TUR). In the other 2 patient, symptoms. CONCLUSIONS: Urethrorrhagia in childhood is a benign condition in most cases, which is almost always cured spontaneously during the first 2 years of follow-up. Radiological studies as well as endoscopic procedures are unnecessary in the early management of these patients thus being relegated to recurrent or persistent bleeding.

[Intratesticular calcifications in childhood]. / Calcificaciones intratesticulares en la edad pediátrica.

INTRODUCTION: Testicular microlithiasis (TM) represents an uncommon occurrence at paediatrics with a radiological incidence between 0.16 to 0.6% according to reports. The greater use of ultrasound as well as the availability of high-frequency probes has increased the number of incidental TM being diagnosed. MATERIAL AND METHOD: From January 1998 to October 2002 seven children, aged 9 to 13 years (average 11 years and 1 months), were diagnosed of MT in our department. Sonographic appearance was hyperechogenic multiple small foci of 1-3 mm without acoustic shadowing of the testicular parenchyma. AIM: To evaluate sonographic patterns of TM, their associations, clinical consequences and to determine their management. RESULTS: All children were asymptomatic and the reasons for the ultrasound were: cryptorchism (3), short height (1), gynecomastia (1), varicocele (1) and scrotum trauma (1). It should be noted that 3 of the cases showed bilateral TM. Out of 10 testicles with TM, 8 met classic testicular microlithiasis (CTM) criteria (at least one image that showed five or more microliths in either or both testes) and 2 had limited testicular microlithiasis (LTM) (to have at least one microlith). Clinical and radiological follow-up is being performed annually, ranging from 18 months to 6 years, during which there hasn't been progression or regression in the number of TM or in their distribution. In none of these cases there has been shown a related testicular cancer. CONCLUSIONS: In other broad reviews it has been shown that there is no evidence to suggest that the TM have to be considered as premalignant lesions by themselves. However, the association among TM and cancer exists. Because of that, and due to the lack of consensus, we recommend annual clinical and radiological (ultrasound) follow-up until puberty, and thereafter the patient should be informed of unknown natural history of this condition. We do not recommend more invasive procedures such as biopsy except: 1) apart form the TM there is a change in the echogenicity or 2) if there is a change in the number or distribution of the TM.

[Torsion of undescended testis]. / Torsión testicular en testes no descendidos.

Torsion of a cryptorchidid testicle presents a non-specific symptomatology. Clinical suspicion indicates surgical exploration, irrespective of Doppler ultrasound with its inherent false negative results. With regards to treatment, an orchiectomy is performed when the testis is necrotic. Management of the contralateral testis is controversial. Our policy is not to fix them systematically because we believe that a healthy education of parents and children is more important, so as to obtain an earlier diagnosis of a future torsion.

[Parameatal urethral cysts. 3 new paediatric cases and literature review]. / Quistes uretrales parameatales. 3 nuevos casos pediátricos y revisión de la literatura.

We present 3 new cases of urethral parameatal cysts in paediatric age. Literature is reviewed and histological data and ambulatory management are discussed.

Valoración de la uretrorragia en el niño / Assessmment urethrorrhagia in childhood

Objetivo: Revisar los casos de uretrorragia, la necesidad de exploraciones complementarias, su manejo e historia natural. Material y Métodos: Analizamos retrospectivamente 12 pacientes que presentaron una uretrorragia, diagnosticados de forma consecutiva en nuestro centro. Se evaluaron parámetros como la edad, tiempo de evolución y hábito miccional. De igual modo, describimos las técnicas diagnósticas utilizadas, el manejo terapéutico y la evolución del paciente. Resultados: Todos los casos corresponden a varones con edad media de 8,7 años (18 meses y 14 años). Los episodios de uretrorragia aparecen en el 100% de los pacientes, mientras que fueron diarios en el 58,4%. El 33% (4/12) se acompañan además de otra sintomatología miccional. El 75% (9/12) presentaban un hábito miccional perezoso. Entre los antecedentes urológicos destacan: 1 paciente circuncidado hacía 3 años, otro al que se le practicó una meatotomía por estenosis del meato 2 años antes y por último, uno al que se le realizó una electrocoagulación de un pólipo uretral hacía un mes. El 83,4% (10/12) de los urinocultivos realizados fueron negativos. Se practicó uretrocistoscopia en 9 pacientes, detectando en 4 una hipertrofia del verum, en 3 cambios inflamatorios adyacentes a la uretra membranosa, en 1 paciente esfacelos en uretra bulbar y en el último no se objetivaron hallazgos patológicos. De los 8 pacientes que presentaban un hábito miccional perezoso, el 75% (6/8) se resolvieron espontáneamente después de corregir el hábito miccional tras una media de 9 meses. Sólo 2 precisaron tratamiento quirúrgico mediante resección endoscópica transuretral. En los otros 2 pacientes la sintomatología desapareció espontáneamente en el transcurso del seguimiento de los mismos. Conclusiones: La uretrorragia en el niño es un proceso benigno en la gran mayoría de los casos, que se resuelve de forma espontánea prácticamente siempre durante los 2 primeros años de seguimiento. Los estudios radiológicos y las exploraciones endoscópicas resultan innecesarios en el manejo inicial de estos pacientes quedando relegadas a cuadros persistentes en el tiempo

Objetive. To review urethrorrhagia cases, the need of complementary test, its management and natural history. Material and method. A retrospective analysis was carried out for the 12 patients who suffered from urethrorrhagia, consecutively diagnosed in our department. Parameters as age, and micturitional habit were evaluated. In this way, we described the diagnostic techniques used, assessment and the follow-up of each patient. Results. All cases correspond to male children with an average age of 8.7 years (range: 18 months- 14 years). Urethrorrhagia appears in 100% of the patients, episodes which were daily in 58.4%. 33% (4/12) of them also present other micturitional symptoms. 75% (9/12) had a lazy micturitional habit. Among the urological backgrounds we found: 1 patient was circumcised 3 years ago, a meatotomy was done in other due to meatus stenosis 2 years before, and a last one had an electrocoagulation of a urethral polyp just 1 month before. 83.4% (10/12) of urine cultures were negative. An urethrocystoscope was done in 9 patients finding a verum hypertrophy in 4, inflammatory changes next to membranous urethra in 3, scar at the bulbar urethra in 1 and in a last one no abnormalities were found. Out of 8 patients with lazy micturitional habit, 75% (6/8) resolve spontaneously once they correct their habits after a mean follow-up of 9 months. Only 2 patients needed surgery (TUR). In the other 2 patient, symptoms. Conclusions. Urethrorrhagia in childhood is a benign condition in most cases, which is almost always cured spontaneously during the first 2 years of follow-up. Radiological studies as well as endoscopic procedures are unnecessary in the early management of these patients thus being relegated to recurrent or persistent bleeding