Enuresis: clinical evolution of patients attended at specialized unit of paediatric urology

OBJECTIVE: To analyse the clinical evolution, the therapeutic strategies and the characteristics of the patients presenting enuresis attended at our outpatient clinic. MATERIAL AND METHODS: Retrospective study of patients <14 years old(yo) diagnosed of enuresis attended at our outpatient clinic (2011-2019) and completed their follow-up (remission or aged 15). Urotherapy was offered to all patients as initial management. The therapeutic strategies were classified as: first line (desmopressin or clock alarm), second line (desmo-pressin+alarm) and third line(anticholinergics). The remission rate during follow-up, the number of consultations needed until remission and the treatments used were calculated. Statistical tests used:Kaplan-Meier, actuarial survival. Multivariate analysis:Cox regression.Statistical significance:p<0.05. RESULTS: Data were collected from 125 patients (mean age: 8.6±2.45yo). Family history of enuresis was present in 38.9%. The mean follow-up was 2.37±1.55yo and the average number of consultations was 7.54±5.06. The remission rate (RE) was 84%(n=105), with a median remission interval:2.66 years (2.34-2.991[95%CI]). The average number of treatments required for remission was 2.74±1.27. RE with urotherapy alone was 20%(n=25); RE with first line:19.3%(n=17) and second line:16.7(n=11). In the remaining patients, a RE of 78.18%(n=43) was achieved by adding an anticholinergic. Patients aged > 8.7 years at the beginning of the follow-up required less time to achieve remission (p=.025). These patients had a higher RE (hazard ratio 1.15 (1.05-1.25))(p=.004). No other variables were significant. CONCLUSION: Staged therapeutic strategies are necessary to achieve remission. Only 25% remitted with urotherapy as single treatment. RE are higher when patients are >8.7 yo once they initiate their follow up (AU)

A pesar de la existencia de lasguías clínicas sobre el manejo terapéutico de la enuresis,un gran porcentaje de estos pacientes son resistentes altratamiento.OBJETIVO: Analizar la evolución clínica, las estrategias terapéuticas y las características de los pacientescon enuresis de nuestra unidad deMATERIAL Y MÉTODOS: Estudio retrospectivode pacientes menores de 14 años con enuresis atendidos ennuestro servicio (2011-2019) y que hayan completado suseguimiento (remisión o edad > 15 años). La uroterapia seofreció como tratamiento inicial en todos. Las siguientesestrategias terapéuticas fueron: primera línea terapéutica(desmopresina o alarma), segunda(desmopresina+alarma)y tercera(anticolinérgicos). Se calculó el porcentaje deremisión (RE) durante el seguimiento, el número de consultas empleadas hasta la RE y el tratamiento utilizado.Test estadísticos:Kaplan-Meier, supervivencia acumulada.Análisis multivariante:Regresión Cox. Significación estadística: p<0.05.RESULTADOS: Se recogieron datos de 125 pacientes(media de edad: 8.6±2.45 años). Los antecedentesfamiliares de enuresis fueron del 38.9%. La media de edadde seguimiento fue 2.37±1.55 años y el número mediode consultas fue de 7.54±5.06. El porcentaje de RE fuede 84%(n=105), con una mediana de intervalo de RE de2.66 años(2.34-2.991[95%CI]. La media de tratamientosempleados fue de 2.74±1.27. La RE con sólo uroterapiafue del 20%(n=25); RE con primera línea de tratamiento:19.3%(n=17) y con segunda: 16.7(n=11). En el resto, laRE fue del 78.18%(n=43) añadiendo anticolinérgicos. Lospacientes mayores de 8.7 años en el inicio del seguimientonecesitaban menor tiempo para conseguir la RE(p=.025).Estos pacientes tenían un porcentaje mayor deCONCLUSIONES: Es necesario emplear estrategiasescalonadas para la remisión. Solo un cuarto remite conuroterapia aislada. Es importante la edad de los pacientesen el inicio del seguimiento pues el porcentaje...(AU)

En bloc resection vs. Gips procedure in pilonidal sinus surgery. / Resección en bloque vs. técnica de Gips en cirugía del sinus pilonidal.

INTRODUCTION: Pilonidal sinus (PS) is an infectious/inflammatory condition of the sacrococcygeal region, with frequent relapses. There is no clear consensus as to which management technique is best. The most widely used technique is en bloc resection (EBR), but less invasive methods (Gips procedure) are now being developed. OBJECTIVE: To compare complications and progression of pediatric patients undergoing PS surgery in our institution using two different surgical techniques. MATERIAL AND METHODS: A retrospective study of patients under 16 years of age undergoing PS surgery (EBR/Gips procedure) for the first time from 2014 to 2020 was carried out. Demographic variables, complications in the first month (exudate, wound infection, dehiscence, and bleeding), and result at the end of follow-up were collected. Qualitative variables were expressed as absolute frequency and percentage, whereas quantitative variables were expressed as mean and standard deviation. RESULTS: 60 patients underwent surgery. EBR was used in the first group, and the Gips procedure was used in the second group (76.67%, n = 46 vs. 23.33%, n = 14). Both were comparable in terms of sex (32.61% vs. 35.71% male), age (14.04 vs. 13.79 years old), and BMI (26.63 vs. 26.20 kg/m2) at surgery. 6 patients underwent re-intervention (10.87% vs. 7.14%; p = 0.684). Median follow-up time to healing was 6.13 ± 0.98 months vs. 3.31 ± 1.26 months (p < 0.024). The Gips procedure caused no dehiscence, whereas dehiscence rate in EBR was 65.22%. CONCLUSION: The Gips procedure is a minimally invasive alternative to EBR. It avoids dehiscence, and time to healing is shorter. Therefore, it should be regarded as the first-line treatment in PS patients.

INTRODUCCION: El sinus pilonidal (SP) es una enfermedad infecciosa/inflamatoria de la región sacrococcígea, que asocia recaídas frecuentes, sin un consenso claro sobre su manejo óptimo. La técnica más empleada es la resección en bloque (RB), pero se están desarrollando métodos menos invasivos (técnica de Gips). OBJETIVOS: Comparar las complicaciones y evolución de pacientes pediátricos intervenidos de SP en nuestro centro con dos técnicas quirúrgicas diferentes. MATERIAL Y METODOS: Estudio retrospectivo de pacientes menores de 16 años intervenidos por primera vez de SP (RB/técnica de Gips) entre 2014 y 2020. Se recogieron variables demográficas, complicaciones en el primer mes (exudado, infección de herida, dehiscencia, sangrado) y resultado al final del seguimiento. Las variables cualitativas se expresaron mediante frecuencia absoluta y porcentaje, y las cuantitativas mediante media y desviación estándar. RESULTADOS: Se intervinieron 60 pacientes: el primer grupo mediante RB y el segundo mediante técnica de Gips (76,67%, n = 46 vs. 23,33%, n = 14). Ambos fueron comparables en cuanto a sexo (32,61% vs. 35,71% varones), edad (14,04 vs. 13,79 años) e IMC (26,63 vs. 26,20 kg/m2) durante la cirugía. Se reintervinieron 6 pacientes (10,87% vs. 7,14%; p = 0,684). La mediana del tiempo de seguimiento hasta la curación fue de 6,13 ± 0,98 vs. 3,31 ± 1,26 meses (p < 0,024). La técnica de Gips no presenta dehiscencias, a diferencia de la RB con un 65,22%. CONCLUSION: La técnica de Gips es una alternativa mínimamente invasiva a la RB, que evita la dehiscencia y precisa menos tiempo en alcanzar la curación, por lo que debería emplearse como tratamiento de primera elección.

Resección en bloque vs. técnica de Gips en cirugía del sinus pilonidal / En bloc resection vs. Gips procedure in pilonidal sinus surgery

Introducción: El sinus pilonidal (SP) es una enfermedad infecciosa/inflamatoria de la región sacrococcígea, que asocia recaídas frecuentes,sin un consenso claro sobre su manejo óptimo. La técnica más empleadaes la resección en bloque (RB), pero se están desarrollando métodosmenos invasivos (técnica de Gips).Objetivo. Comparar las complicaciones y evolución de pacientespediátricos intervenidos de SP en nuestro centro con dos técnicas qui-rúrgicas diferentes.Material y métodos: Estudio retrospectivo de pacientes < 16 añosintervenidos por primera vez de SP (RB/técnica de Gips) entre 2014 y2020. Se recogieron variables demográficas, complicaciones en el primermes (exudado, infección de herida, dehiscencia, sangrado) y resultado alfinal del seguimiento. Las variables cualitativas se expresaron mediantefrecuencia absoluta y porcentaje, y las cuantitativas mediante media ydesviación estándar.Resultados: Se intervinieron 60 pacientes: el primer grupo me-diante RB y el segundo mediante técnica de Gips (76,67%, n = 46 vs.23,33%, n = 14). Ambos fueron comparables en cuanto a sexo (32,61%vs. 35,71% varones), edad (14,04 vs. 13,79 años) e IMC (26,63 vs. 26,20kg/m 2 ) durante la cirugía. Se reintervinieron 6 pacientes (10,87% vs.7,14%; p = 0,684). La mediana del tiempo de seguimiento hasta la cu-ración fue de 6,13 ± 0,98 vs. 3,31 ± 1,26 meses (p < 0,024). La técnicade Gips no presenta dehiscencias, a diferencia de la RB con un 65,22%.Conclusiones: La técnica de Gips es una alternativa mínimamenteinvasiva a la RB, que evita la dehiscencia y precisa menos tiempo enalcanzar la curación, por lo que debería emplearse como tratamientode primera elección.

Introduction: Pilonidal sinus (PS) is an infectious/inflammatorycondition of the sacrococcygeal region, with frequent relapses. Thereis no clear consensus as to which management technique is best. Themost widely used technique is en bloc resection (EBR), but less invasivemethods (Gips procedure) are now being developed.Objective: To compare complications and progression of pediatricpatients undergoing PS surgery in our institution using two differentsurgical techniques.Materials and methods: A retrospective study of patients under 16years of age undergoing PS surgery (EBR/Gips procedure) for the firsttime from 2014 to 2020 was carried out. Demographic variables, com-plications in the first month (exudate, wound infection, dehiscence, andbleeding), and result at the end of follow-up were collected. Qualitativevariables were expressed as absolute frequency and percentage, whereasquantitative variables were expressed as mean and standard deviation.Results: 60 patients underwent surgery. EBR was used in the firstgroup, and the Gips procedure was used in the second group (76.67%,n = 46 vs. 23.33%, n = 14). Both were comparable in terms of sex(32.61% vs. 35.71% male), age (14.04 vs. 13.79 years old), and BMI(26.63 vs. 26.20 kg/m2) at surgery. 6 patients underwent re-intervention(10.87% vs. 7.14%; p = 0.684). Median follow-up time to healing was6.13 ± 0.98 months vs. 3.31 ± 1.26 months (p < 0.024). The Gips proce-dure caused no dehiscence, whereas dehiscence rate in EBR was 65.22%.Conclusions: The Gips procedure is a minimally invasive alternativeto EBR. It avoids dehiscence, and time to healing is shorter. Therefore,it should be regarded as the first-line treatment in PS patients.

Utilidad clínica de la medición del área máxima del trazado del detrusor en el estudio urodinámico en el paciente pediátrico con vejiga neuropática: estudio piloto / Clinical utility of the maximum area of detrusor tracing measurement in the urodynamic studies in pediatric population diagnosed with neuropathic bladder: A pilot study

IntroducciónLa vejiga neuropática (VN) es una disfunción del tracto urinario inferior (DTUinf) con riesgo de deterioro de la función renal, siendo el estudio urodinámico (EUD) la prueba patrón para su diagnóstico y seguimiento. El parámetro urodinámico clásico para identificar el riesgo renal es la presión de fuga del detrusor>=40 cmH2O, aunque este valor aislado puede carecer de interés pronóstico. Recientemente se ha descrito el área bajo la curva (ABC) del trazado de la presión del detrusor como factor pronóstico.ObjetivoAnalizar la utilidad clínica del ABC del trazado de la presión del detrusor en edad pediátrica (< 15 años).MétodosEstudio retrospectivo de registros urodinámicos en población pediátrica con VN entre 2011-2020. Se registran: presión detrusor y de fuga ≥ 40 cmH2O, alteración de la acomodación, vaciado e hiperactividad detrusor. Se clasifica la muestra según evolución clínica-radiológica en el momento del EUD. Se calcula el ABC utilizando los métodos de Newton-Côtes (trapecios, Simpson compuesto) y se calculan sus índices según la capacidad vesical (índice trapecios [IT]; índice Simpson [IS]). Significación estadística: p<0,05.ResultadosSe analizan 55 registros. El 41,8% (n=23) tuvo una evolución clínica desfavorable. La alteración en el vaciado, la hipoacomodación y los índices se asociaron a una situación clínica desfavorable(p <0,05). El ABC del rendimiento diagnóstico de los nuevos índices fue: IT (0,736, p=0,0006); IS (0,755, p=0,0001). Los puntos de corte del valor de IT e IS fueron de 10,69 y 8 cmH2O×s/cc, respectivamente. No encontramos diferencias en el rendimiento diagnóstico entre ellos (p> 0,05).ConclusionesLos nuevos índices estudiados son útiles en el diagnóstico de pacientes con VN y situación clínica desfavorable (AU)

IntroductionNeuropathic bladder (NB) is a lower urinary tract dysfunction (LUTD) that may lead to kidney failure. Urodynamic study is the gold standard for its diagnosis and follow-up. A classic prognostic parameter to predict the risk of upper urinary tract damage (UUTD) is the detrusor leak point pressure (DLPP)>=40cmH2O, although this factor alone may lack prognostic value. The area under the curve (AUC) of the detrusor pressure tracing has been recently described as a prognostic factor.AimTo analyze the clinical utility of the AUC of the detrusor pressure tracing in the pediatric population (<15 years).MethodsRetrospective study of urodynamic recordings in pediatric population with NB from 2011 to 2020. The following variables were evaluated: detrusor leak point pressure>=40cmH2O, voiding dysfunction, bladder compliance and overactivity. The sample is classified according to clinical-radiological findings at the time of the UD. AUC is calculated using Newton-Cotes rules (trapezium, Simpson's rule) and its indexes are calculated according to bladder capacity (TI: Trapezium Index, SI: Simpson Index). Statistical significance: P<.05.ResultsFifty-five recordings are analyzed. Unfavorable clinical condition was identified in 41.8% (n=23) patients. Voiding dysfunction, low compliance and both indexes were associated with an unfavorable clinical condition (P<.05). ROC analysis showed the following AUC for the new indexes: TI (0.736, P=.0006), SI (0.755, P=.0001) with a cut-off value of 10,69 and 8cmH2Os/cc, respectively. We did not find differences in the diagnostic performance between them (P>.05).ConclusionsThe analyzed indexes are useful in the diagnosis of patients with NB and unfavorable clinical condition (AU)

Clinical utility of the maximum area of detrusor tracing measurement in the urodynamic studies in pediatric population diagnosed with neuropathic bladder: A pilot study.

INTRODUCTION: Neuropathic bladder (NB) is a lower urinary tract dysfunction (LUTD) that may lead to kidney failure. Urodynamic study is the gold standard for its diagnosis and follow-up. A classic prognostic parameter to predict the risk of upper urinary tract damage (UUTD) is the detrusor leak point pressure (DLPP) ≥  40 cmH2O, although this factor alone may lack prognostic value. The area under the curve (AUC) of the detrusor pressure tracing has been recently described as a prognostic factor. AIM: To analyze the clinical utility of the AUC of the detrusor pressure tracing in the pediatric population (<15 years). METHODS: Retrospective study of urodynamic recordings in pediatric population with NB from 2011 to 2020. The following variables were evaluated: detrusor leak point pressure ≥ 40 cmH2O, voiding dysfunction, bladder compliance and overactivity. The sample is classified according to clinical-radiological findings at the time of the UD. AUC is calculated using Newton-Cotes rules (trapezium, Simpson's rule) and its indexes are calculated according to bladder capacity (TI: Trapezium Index, SI: Simpson Index). Statistical significance: P < .05. RESULTS: Fifty-five recordings are analyzed. Unfavorable clinical condition was identified in 41.8% (n = 23) patients. Voiding dysfunction, low compliance and both indexes were associated with an unfavorable clinical condition (P < .05). ROC analysis showed the following AUC for the new indexes: TI (0.736, P = 0.0006), SI (0.755, P = .0001) with a cut-off value of 10,69 and 8 cmH2O·s/cc, respectively. We did not find differences in the diagnostic performance between them (P > .05). CONCLUSIONS: The analyzed indexes are useful in the diagnosis of patients with NB and unfavorable clinical condition.

High-flow priapism in pediatric population: Case series and review of the literature.

INTRODUCTION: Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. PATIENTS AND METHODS: Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. RESULTS: A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. CONCLUSIONS: High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

High-flow Priapism in Pediatric Population: Case Series and Review of the Literature. / Priapismo de alto flujo en población pediátrica: serie de casos y revisión de la literatura.

INTRODUCTION: Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. PATIENTS AND METHODS: Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. RESULTS: A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. CONCLUSIONS: High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

Análisis de la percepción del dolor asociado al estudio urodinámico en niños mayores de tres años / Analysis of pain perception associated with urodynamic testing in children over 3 years old

Objetivo: Medir la tolerancia del estudio urodinámico (EUD) en el paciente pediátrico, mediante una escala visual analógica. Analizar qué variables clínicas y relacionadas con el EUD influyen en la percepción del dolor.Material y métodosEstudio transversal de 139 pacientes pediátricos tras un EUD (entre diciembre del 2013 a mayo del 2018). Criterio de inclusión: entender y expresar su experiencia tras el EUD (edad preescolar y escolar). No se incluyeron adolescentes.La herramienta de evaluación: escala visual analógica del dolor (EVA 0-10). Se obtuvieron otras variables clínicas y asociadas al EUD. Análisis estadístico: U de Mann-Whitney, Kruskal-Wallis. Análisis de correlación de Spearman (rs). Análisis multivariante mediante regresión logística ordinal. Significación p < 0,05.ResultadosMedia de edad 7,7 años (DE 2,4), mediana puntuación EVA, 2 (2-6). En un 41% (n = 57), la puntuación fue ≥ 4 (dolor moderado). Análisis multivariante. Variables explicativas de obtener una puntuación EVA alta: puntuación APEUD alta (identificar en el paciente nerviosismo previo al EUD), alteración sensitivo-motora de MMII, una dificultad en el sondaje vesical y que aparezca dolor durante el llenado. La edad y el tiempo de duración del EUD no han influido en dicha puntuación EVA.ConclusionesAunque el EUD ha generado que un 40% de los pacientes pediátricos de nuestro estudio expresaran molestias o dolor, es una prueba bien tolerada.Las variables que han influido en la percepción del dolor han sido: el nerviosismo del paciente previo al EUD, una alteración sensitivo-motora localizada en metámeras lumbosacras, una dificultad en el sondaje vesical y que aparezca dolor durante el llenado vesical. (AU)

Objective: To measure the tolerance of urodynamic testing (UDT) in the pediatric patient by means of the Visual Analog Scale (VAS). To analyze which clinical and UDT-related variables influence pain perception. Material and methods. Cross-sectional study of 139 pediatric patients undergoing UDT (December 2013 - May 2018). Inclusion criteria: understanding and expressing their experience after UDT (preschool and school age). No adolescents were included.Measurement instrument Visual Analog Scale (0-10). Other clinical and UDT-associated variables were obtained. Statistical analysis: Mann-Whitney U test, Kruskal Wallis test. Spearman's rank correlation analysis (rs). Multivariate analysis through ordinal logistic regression. Significance p < 0.05.ResultsMean age 7.7 years (SD 2.4), median VAS score, 2 (2-6). In 41% (n = 57), the score was ≥ 4 (moderate pain). Multivariate analysis. Explanatory variables for obtaining a high VAS score: high APUDT score (identifying patient anxiety prior to UDT), sensory-motor alteration in the lower limbs, difficult bladder catheterization and the appearance of pain during the filling phase. Age and duration of the UDT have not influenced the VAS score.ConclusionsAlthough the UDT has resulted in 40% of the pediatric patients in our study expressing discomfort or pain, it is a well-tolerated test.The variables that have influenced on pain perception were patient's anxiety prior to UDT, a sensory-motor alteration located in the lumbosacral metameres, difficult bladder catheterization and the appearance of pain during bladder filling. (AU)

Analysis of pain perception associated with urodynamic testing in children over 3 years old. / Análisis de la percepción del dolor asociado al estudio urodinámico en niños mayores de tres años.

OBJECTIVE: To measure the tolerance of urodynamic testing (UDT) in the pediatric patient by means of the Visual Analog Scale (VAS). To analyze which clinical and UDT-related variables influence pain perception. MATERIAL AND METHODS: Cross-sectional study of 139 pediatric patients undergoing UDT (December 2013 - May 2018). INCLUSION CRITERIA: understanding and expressing their experience after UDT (preschool and school age). No adolescents were included. Measurement instrument Visual Analog Scale (0-10). Other clinical and UDT-associated variables were obtained. STATISTICAL ANALYSIS: Mann-Whitney U test, Kruskal Wallis test. Spearman's rank correlation analysis (rs). Multivariate analysis through ordinal logistic regression. Significance p < 0.05. RESULTS: Mean age 7.7 years (SD 2.4), median VAS score, 2 (2-6). In 41% (n = 57), the score was ≥ 4 (moderate pain). Multivariate analysis. Explanatory variables for obtaining a high VAS score: high APUDT score (identifying patient anxiety prior to UDT), sensory-motor alteration in the lower limbs, difficult bladder catheterization and the appearance of pain during the filling phase. Age and duration of the UDT have not influenced the VAS score. CONCLUSIONS: Although the UDT has resulted in 40% of the pediatric patients in our study expressing discomfort or pain, it is a well-tolerated test. The variables that have influenced on pain perception were patient's anxiety prior to UDT, a sensory-motor alteration located in the lumbosacral metameres, difficult bladder catheterization and the appearance of pain during bladder filling.

Evaluation of sleep hygiene and prevalence of sleep disorders in patients with monosymptomatic enuresis. Usefulness of the BEARS sleep screening tool. / Evaluación de la higiene del sueño y la prevalencia de sus alteraciones en los pacientes con enuresis monosintomática. Utilidad del cuestionario BEARS.

OBJECTIVES: To analyze if there is a higher prevalence of sleep disturbances and hygiene disorders in patients with monosymptomatic enuresis (MEN) with respect to general population and to patients with corrected MEN. Assess the usefulness of the BEARS sleep disorder screening tool for children with MEN. MATERIAL AND METHODS: Transverse observational study (n=341) classified as: MEN (n=122), corrected MEN (≥ 1 one year without recurrence) (ANTENUR) (n=47) and controls (n=172). The BEARS childhood sleep disorder screening questionnaire was used. Clinical variables were collected, as well as variables related to sleep hygiene. STATISTICS: Chi-square, Student's t, ANOVA, Mann-Whitney U and Kruskal-Wallis. Significance p<.05. RESULTS: Mean age 9.7±3.0 years. There were no statistically significant differences in terms of age, sex, BMI, history of tonsillectomy, asthma and sleep time hours. With respect to sleep hygiene, patients with MEN presented a higher percentage of alterations than controls. As for the BEARS questionnaire, it showed a higher prevalence of sleep disorders in the group of patients with MEN, with respect to the other two groups: 60.7% (n=74) versus 18.6% (n=32) and 38.3% (n=18) of controls and ANTENUR, respectively (p<.05). CONCLUSIONS: Children with MEN had a higher prevalence of sleep disturbances and sleep disorders than controls. The BEARS questionnaire is a useful clinical tool in the detection of sleep disorders in children.

Spontaneous spermatic vein thrombosis in pediatric patients: A condition to be considered. / Trombosis espontánea de la vena espermática en la edad pediátrica: una entidad a tener en cuenta.

Spermatic vein thrombosis is a very rare pathology, with 25 cases published only, 6 of which in patients under 15 years of age. We present the case of a male patient, as well as a review of the literature. A 12-year old boy presented at emergency with 3-day progressive testicular pain. Following abdominal Doppler ultrasound imaging, he was diagnosed with left spermatic vein thrombosis and nutcracker syndrome. Admission and enoxaparin treatment were decided upon. Patient evolution was satisfactory, with subsequent ultrasound imaging demonstrating the absence of thrombus. The patient is currently under follow-up and without treatment. Various treatments are mentioned in the literature, with conservative management being the treatment of choice.

La trombosis de la vena espermática es una patología muy poco frecuente, con solo 25 casos publicados, 6 de los cuales menores de 15 años. De esta manera presentamos el caso de un varón, así como la revisión de la literatura. Un paciente de 12 años de edad acudió a Urgencias por dolor testicular de aumento progresivo, de 3 días de evolución. Mediante ecografía doppler abdominal se diagnosticó de trombosis de la vena espermática izquierda y síndrome de cascanueces. Se decidió ingreso y tratamiento con enoxaparina. La evolución del paciente fue satisfactoria, en la ecografía posterior se observó la desaparición del trombo. El paciente se encuentra en seguimiento y sin tratamiento. Existen varios tratamientos reflejados en la literatura, siendo el de elección el manejo conservador.

Usefulness of the classification of urinary dysfunction for the prognosis of the first endoscopic treatment of vesicoureteral reflux in children over the age of 3. / Utilidad de la clasificación de los patrones de disfunción miccional en el pronóstico del primer tratamiento endoscópico del reflujo vesicoureteral en niños mayores de 3 años.

OBJECTIVES: To assess the diagnostic performance of urinary dysfunction patterns associated with vesicoureteral reflux (VUR) in children over the age of 3 according to the result of the first endoscopic treatment (ENDT1), grouped into a classification designed by our group (CMD.URI-La Fe). Comparison with other current classifications such as that of Van Batavia et al. MATERIAL AND METHODS: Ambispective cross-cutting study of a sample of 50 children. EXCLUSION CRITERIA: previous ENDT, age ≤ 3 years, anatomical or neurological anomalies and a history of ureteral or abdominopelvic surgery. Prior to the ENDT1, a bladder voiding function assessment by uroflowmetry+electromyography (UF-EMG) and post-mictional residue (ultrasound). Other variables from the bladder diary, pre-mictional bladder wall thickness and other clinical variables. The correction of VUR was assessed by isotope cystography 3 months after the treatment. Urinary patterns were classified according to the significant variables (URI-La Fe), and the diagnostic performance of this classification was assessed, comparing it to the classification of patients as proposed by Van Batavia et al. RESULTS: Mean age: 6.8±2.28 years. Males/females (44%/56%). Grades of VUR (mild/moderate/severe). ENDT1 VUR correction rate: 77% (n=38). Diagnostic performance (Van Batavia; URI-La Fe): correct prediction (37.5%; 75%), sensitivity (32.4%; 87.8%), specificity (54.5%; 46.6%), positive predictive value (70.6; 78.3%) and negative predictive value (19.4%; 63.6%). CONCLUSIONS: Our results show the usefulness of the non-invasive test and the classification of urinary dysfunction in children aged over 3 years prior to the first endoscopic treatment of VUR.

[Experience in the conservative treatment of renal trauma]. / Experiencia en el tratamiento conservador del traumatismo renal.

OBJECTIVE: The management of renal trauma has been changing in recent years so that nowadays, even in high grades, an initial conservative treatment is advocated. The aim of this work is to review the presentation, initial attitude and evolution of the renal traumas treated in our institution. MATERIAL AND METHODS: Retrospective review of patients with renal trauma treated at our institution in the last 10 years. Epidemiological variables, production mechanism, pediatric trauma index (PTI), treatment and evolution were analyzed. RESULTS: We studied 26 patients, 18 men (69.3%). The most frequent mechanism was the direct hit in 11 patients (42.31%). The most frequently side affected was the right one in 14 patients (53.85%). The grade III traumatism according to American Association for the surgery of Trauma (AAST) was the most repeated, 11 patients (42.31%). Nine patients (44.55%) presented concomitant injuries in other solid organs. In 24 patients (92.30%) the initial treatment was conservative with supportive measures. One patient presented with hemodynamic instability and an urgent intervention was conducted, performing a supraselective embolization with immediate control of the active bleeding. In another patient, a double J catheter was placed due to disruption of the excretory tract. Of the patients treated conservatively initially, only one patient (4.1%) required secondary surgical maneuvers due to a complication. CONCLUSIONS: In patients with renal trauma, non-surgical treatment is safe and effective. In case of hemodynamic instability or complication, interventional radiological techniques have been demonstrated to be safe and effective in the pediatric population.

OBJETIVO: El manejo del traumatismo renal ha ido variando en los últimos años de modo que en la actualidad, incluso en los grados altos, se aboga por un tratamiento inicial conservador. El objetivo de este trabajo es revisar la presentación, actitud inicial y evolución de los traumatismos renales atendidos en nuestra institución. MATERIAL Y METODOS: Revisión retrospectiva de pacientes con traumatismo renal atendidos en los últimos 10 años. Se analizaron las variables epidemiológicas, mecanismo de producción, índice de trauma pediátrico (ITP), tratamiento y evolución. RESULTADOS: Se estudiaron 26 pacientes, 18 varones (69,23%). La causa más frecuente fue el golpe directo en 11 pacientes (42,31%). El lado más frecuentemente afectado fue el derecho en 14 pacientes (53,85%). El traumatismo grado III según la American Association for the Surgery of Trauma (AAST) fue el más común, 11 pacientes (42,31%). Nueve pacientes (44,55%) presentaron lesiones concomitantes en otros órganos sólidos. En 24 pacientes (92,30%) el tratamiento inicial fue conservador con medidas de soporte. Un paciente se presentó con inestabilidad hemodinámica y se intervino de forma urgente realizándose embolización supraselectiva con control inmediato del sangrado activo. En otro paciente se colocó un catéter doble J por disrupción de la vía excretora. De los pacientes tratados de manera conservadora inicialmente solo 1 paciente (4,1%) requirió maniobras quirúrgicas secundarias debido a una complicación. CONCLUSIONES: En pacientes con traumatismo renal el tratamiento no quirúrgico es seguro y eficaz. En caso de inestabilidad hemodinámica o complicación, las técnicas radiológicas intervencionistas han demostrado ser seguras y efectivas en la edad pediátrica.

hTERT mRNA expression in urine as a useful diagnostic tool in bladder cancer. Comparison with cytology and NMP22 BladderCheck Test®. / Expresión de ARNm de hTERT en orina como herramienta diagnóstica útil en cáncer de vejiga. Comparación con citología y NMP22 BladderCheck Test®.

INTRODUCTION: To study the relationship between quantitative mRNA determination (hTERT) in patients with bladder tumor, history of bladder tumor, and in subjects without a history of this neoplasia. MATERIAL AND METHODS: A prospective randomized controlled study with 91 subjects included. The value of mRNA-hTERTN was determined in 63 patients with a history or suspicion of bladder tumor and in 28 controls. Urine samples were sent for evaluation of the mRNA level (hTERT), the cytological study and the NMP22 result. RESULTS: Differences were observed in mean hTERTN levels in each of the groups: tumor presence 21.33+/- 40.66, tumor history 2.16+/- 2.67, controls 0.9+/- 1, 75 (p<0.001). In patients with tumor, there was no difference in mean hTERTN levels between the different grades and stages, although there was a tendency: low grade tumor 9.04+/- 16.95, high grade 28.95+/- 48.36 (p=.069), stage Ta 10.33+/- 19.39, T1 17.88+/- 27.14, T2 54.8+/- 74.05 (p=.056). In addition, the sensitivity of hTERTN was superior to that of other test (76%), although specificity and positive and negative predictive values were better for cytology (94%, 88.4% and 72.3% respectively) and NMP22 (88%, 80.6% and 73.3% respectively). CONCLUSIONS: hTERTN mRNA levels in urine were higher in patients with bladder tumors compared to patients with a history of bladder tumor and with negative cystoscopy, as well as in the control group. This determination showed a higher diagnostic yield compared with the detection of NMP22 and urinary cytology.

[Risk factors in the failure of surgical repair of pelvic organ prolapse]. / Factores de riesgo en el fracaso de la reparación quirúrgica del prolapso de suelo pelviano.

INTRODUCTION: Pelvic organ prolapse (POP) surgery has variable results of recurrence and complications. We have aimed to analyze our outcomes in order to know the factors associated with anatomical and functional failure in POP surgery. MATERIAL AND METHODS: A retrospective study of 69 patients who underwent POP surgery at our hospital was performed. Registered variables were: Age, BMI, number of deliveries, previous pelvic surgery, menopause, quality of life, urinary incontinence, associated frequency-urgency symptoms, high POP stage, vaginal compartments repaired, type of mesh, urethro-suspension and vaginal hysterectomy during POP surgery and its complications. Patients were evaluated at 1, 6 and 12 months post-surgery. The technique was considered as failed when relapse or mesh erosion occurred and when the patient is not satisfied or there was relapse. The sample is described, analyzing the relationship of the variables studied by univariate analysis (Chi square and Mann-Whitney U test) and a study was made of which variables may have predictive value in the failure of the repair (multiple logistic regression). RESULTS: Surgery failed in 17 patients during the follow-up at one year. BMI (29.6±2.03 vs 27.1±3.32), delivery number (3.4±0.71 vs. 2.8±1.88), menopause, frequency- urgency symptoms and number of vaginal compartments repaired were associated with treatment failure although only BMI, delivery number and frequency-urgency symptoms were defined as independent predictive variables when the logistic regression was carried out. CONCLUSIONS: Overweightness-obesity, previous delivery number and frequency-urgency symptoms before surgery are factors associated to anatomical and functional failure after POP repair.

[Radical cystectomy as a muscle-invasive bladder cancer treatment in elderly patients]. / Cistectomía radical como tratamiento del cáncer vesical infiltrante en el paciente de edad avanzada.

INTRODUCTION: Radical cystectomy in elderly is a controversial issue that increases importance overtime because average life span is growing. OBJECTIVE: The purpose of our work was to analize the differences about perioperative and later outcomes between ages of patients with muscle-invasive bladder neoplasm treated with radical cystectomy. MATERIAL AND METHODS: We retrospectively reviewed the records of patients who underwent radical cystectomy for muscle-invasive bladder cancer. Two age groups were compared: < 70-years-old at time of cystectomy (n = 55) and > or = 70 years (n = 57). RESULTS: There was no difference between both age groups about: time of surgery, intraoperative complications (< 70 = 21,8%, > or = 70 = 31,6%), postoperative mortality (< 70 = 3,6%, > or = 70 = 8,8%), minor (< 70 = 18,2%, > or = 70 = 26,3%) and major medical postoperative complications (< 70 = 7,3%, > or = 70 = 8,8%), late outcomes as cancer-specific morby-mortality and actuarial overall survival stratified by patient age. The rate of major postoperative complications (< 70 = 23,6%, > or = 70 = 43,9%) as well as the mean length of hospital stay (< 70 = 10,2, > or = 70 = 15,2 days) differed significantly between the two age groups. Age and cardiovascular risk factors were independient predictive factors of mayor postoperative complications. CONCLUSIONS: Radical cystectomy could be performed in carefully selected elderly patients.

Cistectomía radical como tratamiento del cáncer vesical infiltrante en el paciente de edad avanzada / Radical cystectomy as a muscle-invasive bladder cancer treatment in elderly patients

Introducción: Realizar una cistectomía radical en ancianos con cáncer vesical infiltrante es un tema controvertido. Objetivo: El objetivo de nuestro trabajo ha sido determinar si existen diferencias significativas en cuanto a la morbimortalidad perioperatoria, complicaciones tardías, tiempo libre de enfermedad y supervivencia cáncer-específica en un grupo de pacientes ancianos con cáncer vesical infiltrante tratados mediante cistectomía radical, comparado al resto de pacientes de menor edad y analizar qué variables pudieron predecir la morbi-mortalidad perioperatoria. Material y métodos: Estudio retrospectivo de pacientes con cáncer vesical infiltrante tratados mediante cistectomía radical y derivación ileal. Se compararon 2 grupos: <70 años en el momento de la realización de la cistectomía (n=55) y≥70 años (n=57). Resultados: No hubo diferencias entre ambos grupos con respecto a: tiempo quirúrgico, complicaciones intraoperatorias (<70=21,8%, ≥70=31,6%), mortalidad postoperatoria (<70=3,6%, ≥70=8,8%), complicaciones postoperatorias menores(<70=18,2%, ≥70=26,3%) y médicas (<70=7,3%, ≥70=8,8%), eventos tardíos, periodo libre de enfermedad y supervivencia cáncer-específica. El porcentaje de complicaciones mayores (<70=23,6%, ≥70=43,9%) y la estancia hospitalaria (<70=10,2,≥70=15,2 días) difieren significativamente entre ambos grupos. La edad y los factores de riesgo cardiacos predicen de manera independiente la aparición de complicaciones postoperatorias mayores. Conclusiones: La cistectomía radical puede ser realizada en pacientes ancianos seleccionados adecuadamente (AU)

Introduction: Radical cystectomy in elderly is a controversial issue that increases importance overtime because average life span is growing. Objetive: The porpouse of our work was to analize the differences about perioperative and later outcomes between ages of patients with muscle-invasive bladder neoplasm treated with radical cystectomy. Material and methods: We retrospectively reviewed the records of patients who underwent radical cystectomy for muscle-invasive bladder cancer. Two age groups were compared: <70 years old at time of cystectomy (n=55) and ≥70 years(n=57).Results: There was no difference between both age groups about: time of surgery, intraoperative complications (<70=21,8%,≥70=31,6%), postoperative mortality (<70=3,6%, ≥70=8,8%), minor (<70=18,2%, ≥70=26,3%) and major medical postoperative complications (<70=7,3%, ≥70=8,8%), late outcomes as cancer-specific morby-mortality and actuarial overall survival stratified by patient age. The rate of major postoperative complications (<70=23,6%, ≥70=43,9%) as well as the mean length of hospital stay (<70=10,2, ≥70=15,2 days) differed significantly between the two age groups. Age and cardiovascular risk factors were independient predictive factors of mayor postoperative complications. Conclusions: Radical cystectomy could be performed in carefully selected elderly patients (AU)

[Hyperammonaemic encephalopathy, possible complication after urinary diversion in radical cystectomy. Review of the literature with regard to a clinical case]. / La encefalopatia hiperamonémica, una posible complicación por derivación urinaria tras cistectomía radical. Revisión de la literatura a proposito de un caso.

INTRODUCTION: Radical cystectomy is an intervention with an important morbidity. Urinary diversion is a possible cause of metabolic complications like hyperammonaemic encephalopathy. CASE REPORT: We present the case of a patient treated with a radical cystectomy and modified ureterosigmoidostomy after diagnosis of bladder cancer. After surgery the patient presented in 4 ocasions recurrent episodic confusion. Laboratory and image tests were normal. Levels of seric ammonium was increased. After supportive treatment and hemodyalisis symptoms disappeared. Later patient was reoperated and a reconstruction to ileal conduit was made. DISCUSSION: Continent urinary diversions are advised due to important negative impact on quality of life produced by ileal conduit. However these diversions have several complications, like encephalopathy secondary to non-hepatic hyperammonaemia. Increased absortion of ammonium by intestinal tissue of the new-ladder induces encephalopathy. Early diagnosis of this complication is essencial in order to administer an effective treatment.