Abordaje mínimamente invasivo del ureterocele en pacientes con duplicidad renoureteral / Endoscopic incision of intravesical ureteroceles in patients with duplex system

Objetivo. Evaluar la situación clínica y la función renal de pacientes con duplicidad renoureteral y ureterocele tras su drenaje mediante cistoscopia. Material y métodos. En 9 pacientes diagnosticados de duplicidad renoureteral se realizó drenaje del ureterocele por presentar infecciones urinarias de repetición (7 niños con episodios de pielonefritis y sepsis) u obstrucción del drenaje urinario. La media de edad fue de 33 meses (rango 8-108 meses). La punción del ureterocele se realizó con anestesia general, en quirófano mediante cistouretroscopia con electrodo en asa. El tiempo mínimo de seguimiento fue de 12 meses (rango 12-48 meses) e incluye ecografía renal, estudio isotópico renal MAG 3 confurosemida y, en los casos con reflujo vesicoureteral preoperatorio o infección urinaria postoperatoria, estudio con ecocistografía. Resultados. El tiempo medio operatorio fue de 60 minutos. La estancia media hospitalaria fue de 48 horas. No se presentaron complicaciones durante la técnica. En cinco pacientes desparecieron los episodios de infección urinaria. La ecografía demostró la disminución de la hidronefrosis y del megauréter. En dos pacientes mejoró la función renal diferencial (FRD). Un paciente con FRD preoperatoria del 14% precisó nefrectomía. Un paciente presentó reflujo vesicoureteral postoperatorio. Conclusiones. El drenaje del ureterocele en pacientes con duplicidad renoureteral reduce los episodios de infección urinaria y la dilatación de la vía urinaria

Purpose. To evaluate the clinical status and renal function of patients with duplex system and intravesical ureterocele after drainage by cystoscopy. Material and methods. In 9 patients with duplex system and intravesical ureterocele drainage was performed to present recurrent urinarytract infections (7 children with episodes of pyelonephritis and sepsis) or obstruction of the urinary drainage. The mean age was 33 months (range 8-108 months). The technique was done under general anesthesia in the operating room and puncture of the ureterocele was performed using cystourethroscopy with loop electrode. The minimum follow-up was 12 months (range 12-48 months) and includes renal ultrasound, renal isotopic study (Mag 3 with furosemide) and echocystography study in patients with preoperative vesicoureteral reflux or postoperative urinary tract infection. Results. The average operative time was 60 minutes. Mean hospital stay was 48 hours. There were no complications during the procedure. In five patients urinary infection episodes disappeared. Ultrasound demonstrated decreased hydronephrosis and megaureter. In two patients the differential renal function following the technique improved. One patient with preoperative split renal function of 14% required nephrectomy. One patient had postoperative vesicoureteral reflux. Conclusions. The drainage of intravesical ureterocele in patients with duplex system reduces episodes of urinary tract infection and urinary tract dilation

[Endoscopic incision of intravesical ureteroceles in patients with duplex system]. / Abordaje mínimamente invasivo del ureterocele en pacientes con duplicidad renoureteral.

PURPOSE: To evaluate the clinical status and renal function of pa- tients with duplex system and intravesical ureterocele after drainage by cystoscopy. MATERIAL AND METHODS: In 9 patients with duplex system and intravesical ureterocele drainage was performed to present recurrent urinary tract infections (7 children with episodes of pyelonephritis and sepsis) or obstruction of the urinary drainage. The mean age was 33 months (range 8-108 months). The thecnique was done under general anesthesia in the operating room and puncture of the ureterocele was performed using cystourethroscopy with loop electrode. The minimum follow-up was 12 months (range 12-48 months) and includes renal ultrasound, renal isotopic study (Mag3 with furosemide) and-echocystography study in patients with preoperative vesicoureteral reflux or postoperative urinary tract infection. RESULTS: The average operative time was 60 minutes. Mean hospital stay was 48 hours. There were no complications during the procedure. In five patients urinary infection episodes disappeared. Ultrasound demonstrated decreased hydronephrosis and megaureter. In two patients the differential renal function following the technique improved. One patient with preoperative split renal function of 14% required nephrectomy. One patient had postoperative vesicoureteral reflux. CONCLUSIONS: The drainage of intravesical ureterocele in patients with duplex system reduces episodes of urinary tract infection and urinary tract dilation.

[First results of the orchiopexy via scrotal approach]. / Primeros resultados de la orquidopexia vía escrotal.

PURPOSE: We present our first results with the technique described by Bianchi and Squire in 1989 for the surgical treatment of undescended testis by scrotal incision as an alternative to the traditional inguinal approach. MATERIALS AND METHODS: Prospective study of patients operated with the diagnosis of cryptorchidism with scrotal orchidopexy from October 2008 through July 2009. INCLUSION CRITERIA: patients with inguinal palpable testis, scrotal orchidopexy, testicular position was assessed at 6 months and/or one year after surgery. All procedures were performed by the same surgeon. Retractile testes were excluded. We studied the preoperative localization of the testis, the average surgical time, presence or absence of the processus vaginalis, conversions to the traditional inguinal orchiopexy, complications and location of six months and one year after surgery. RESULTS: A total of 50 orchidopexy were performed in 39 patients during this period. Aged between 1 and 12 years (mean 5 years, median 4 years). Were located in the intraoperative exam under anesthesia, fifteen testes in the inguinal canal and 35 in the external inguinal ring. Operative times ranged from 15 to 60 minutes (mean 34 minutes). The processus vaginalis was patent in 25 procedures (50%) and were ligated via the scrotal incision. Two patients required conversion to a traditional inguinal approach. All testes were satisfactorily positioned in the scrotum and there were no cases de testicular atrophy or ascent, hernia o hydrocele formation with followup that ranged from 6 months to 1 year. CONCLUSIONS: The technique of orchiopexy with scrotal approach is a safe, well tolerated and reliable method.

Resultados preliminares en la corrección del pectus excavatum con técnica de Welch modificada por Acastello / Preliminary results in the correction of the pectus excavatum with the acastello modified welch technique

Introducción. Las malformaciones congénitas de la pared torácicason un grupo heterogéneo de patología que pueden afectar a los cartílagoscostales, las costillas, el esternón y las escápulas y clavículas. Dentro del tipo I se encuentra el pectus excavatum el cual se caracterizapor la depresión o desplazamiento en sentido posterior del esternón, produciendo una disminución de la distancia entre éste y la columna vertebral. Para su corrección hemos utilizado la técnica de Welch modificada por Acastello, la cual consiste en una resección parcial de losc artílagos costales y la colocación de par de barras o placas preesternales las cuales se fijan unilateralmente en cada hemitórax a nivel lateral y en forma conjunta a nivel esternal. Materia y métodos. Desde octubre del 2008 hasta marzo de 2011hemos valorado a 108 pacientes con malformaciones congénitas de la pared torácica. De los cuales 47 pacientes (el 44%) correspondieron alpectus excavatum. Se realizaron 12 toracoplastias de Welch modificadas por Acastello para la corrección de los mismos. Resultados. En todos los pacientes se han implantado barras preesternales. No se han presentado complicaciones intraoperatorias, la corrección de la deformidad fue muy satisfactorias tanto objetiva como subjetiva para los pacientes, con un seguimiento de 1 mes a 27 meses del periodo postoperatorio. Conclusiones. La toracoplastia de Welch modificada por Acastello es una muy buena opción para la corrección del pectus excavatum, desde el punto de vista estético da muy buenos resultados y presenta escasa morbilidad, la cual se limita a la pared (AU)

Background. Congenital malformations of the chest wall are a heterogeneous group of diseases affecting the costal cartilage, ribs, sternum, scapula and clavicle. The pectus excavatum is characterized by a posterior depression of the sternum. Acastello-Welch technique consists in a partial resection of the costal cartilages adding some bars or plates unilaterally fi xed to the sternum in each hemithorax Materials and methods. From October 2008 to March 2011 we evaluated 108 patients with congenital malformations of the chest wall. Forty-seven patients (44%) had a pectus excavatum and 12 were treated with Acastello-Welch technique. Results. There were no intraoperative complications. After a mean follow up of 27 months, correction of the deformity was very satisfactory both objective and subjective for patients. Conclusions. The Welch thoracoplasty modified by Acastello is a good option for the correction of the pectus excavatum associating little morbidity and good esthetic outcomes (AU)

Primeros resultados de la orquidopexia vía escrotal / First results of the orchiopexy via scrotal approach

Objetivo. Evaluar nuestros resultados con la técnica de orquidopexia mediante incisión escrotal, descrita por Bianchi y Squire en 1989para el tratamiento quirúrgico del testículo no descendido, como alternativa a la técnica estandarizada de doble incisión mediante abordaje inguinal. Material y métodos. Estudio prospectivo de pacientes intervenidos con el diagnóstico de criptorquidia mediante orquidopexia escrotal, desde octubre de 2008 hasta julio del 2009. Criterios de inclusión: pacientes con testículo palpable en región inguinal, orquidopexia víaescrotal realizada por el mismo cirujano y control de la posición testicular a los 6 meses y/o al año de la cirugía. Se excluyeron los testículos retráctiles. Se analiza: localización preoperatoria del testículo, duración de lacirugía, presencia o ausencia del conducto peritoneo-vaginal, reconversiones a la técnica inguinal, complicaciones y localización a los seis meses y al año de la cirugía. Resultados. Durante este periodo se han realizado un total de 50orquidopexias en 39 pacientes, de edades comprendidas entre 1-12 años (..) (AU)

Purpose. We present our first results with the technique described by Bianchi and Squire in 1989 for the surgical treatment of undescended testis by scrotal incision as an alternative to the traditional inguinal approach. Materials and methods. Prospective study of patients operated with the diagnosis of cryptorchidism with scrotal orchidopexy from October 2008 through July 2009.Inclusion criteria: patients with inguinal palpable testis, scrotalorchidopexy, testicular position was assessed at 6 months and / or one year after surgery. All procedures were performed by the same surgeon. Retractile testes were excluded. We studied the preoperative localization of the testis, the average surgical time, presence or absence of the (..) (AU)

[Preliminary results in the correction of the pectus excavatum with the Acastello modified Welch technique]. / Resultados preliminares en la corrección del pectus excavatum con técnica de Welch modificada por Acastello.

BACKGROUND: Congenital malformations of the chest wall are a heterogeneous group of diseases affecting the costal cartilage, ribs, sternum, scapula and clavicle. The pectus excavatum is characterized by a posterior depression of the sternum. Acastello-Welch technique consists in a partial resection of the costal cartilages adding some bars or plates unilaterally fixed to the sternum in each hemithorax. MATERIALS AND METHODS: From October 2008 to March 2011 we evaluated 108 patients with congenital malformations of the chest wall. Forty-seven patients (44%) had a pectus excavatum and 12 were treated with Acastello-Welch technique. RESULTS: There were no intraoperative complications. After a mean follow up of 27 months, correction of the deformity was very satisfactory both objective and subjective for patients. CONCLUSIONS: The Welch thoracoplasty modified by Acastello is a good option for the correction of the pectus excavatum associating little morbidity and good esthetic outcomes.

[Urodynamic evaluation of experimental bladder augmentation with seromuscular colocystoplasty]. / Evaluación urodinámica de ampliación vesical experimental mediante colocistoplastia.

INTRODUCTION: The use of de-epithelialized intestinal segment can avoid the complications associated of use to bowel segments for bladder augmentation. OBJECTIVE: We designed an experimental model New Zealand rabbit with previously reduced bladder capacity, and afterward we performed augmentation cystoplasty with urodynamics comparative effectiveness demucosalized and conventional colocystoplasty techniques. MATERIAL AND METHODS: In thirty-six male New Zealand rabbits fifty percent reduction cystoplasty was carried out. A month later the animals had bladder augmentation. They were randomly divided in two groups: 18 rabbits (group 1) underwent conventional colocystoplasty. In 18 rabbits (group 2) autoaugmentation procedure and demucosalized colocystoplasty was performed. All animals were sacrificed at 8 weeks of bladder augmentation. Urodynamics studies were practiced at beginning of each operation in all of them. RESULTS: Nine rabbits died and twenty-seven were evaluated: 14 rabbits group-1 and thirteen of group-2. The average increase in bladder capacity was 63% in group-1 under conventional colocystoplasty and 17% in group-2 demucosalized colocystoplasty. Average compliance improved to 141% in group-1 and 38% in group-2. CONCLUSIONS: In this study with "small bladder" New Zealand rabbit, the seromuscular colocystoplasty has poor urodynamics result in improving capacity and compliance bladder but conventional colocystoplasty has result effective.

Evaluación urodinámica de ampliación vesicalexperimental mediante colocistoplastia / Urodynamics evaluation of experimental bladder augmentation with seromuscular colocvstoplasty

Introducción: El uso de segmento intestinal desepitelizado en la ampliación vesical, evita las complicaciones atribuidas a la secreción de moco observadas en la enterocistoplastia convencional y previene el potencial riesgo de malignización. Existe una reciente experiencia de uso clínico con esta técnica cuyos resultados deben validarse clínica y experimentalmente. Objetivo: Evaluar urodinámicamente la efectividad de la autoampliación recubierta con intestino demucosado frente a colocistoplastia convencional en un diseño animal de «vejiga reducida». Material y Métodos: En 36 conejos New Zealand con «vejiga reducida» previamente, se realiza ampliación vesical. Se aleatorizan 2 grupos. Grupo 1: EN 18 conejos se practica colocistoplastia convencional. Grupo 2: A otros 18 animales se les realiza colocistoplastia seromuscular consistente en autoampliación recubierta con segmento intestinal demucosado. Todos los animales fueron sacrificados a las 8 semanas de la ampliación. La evaluación urodinámica (capacidad vesical, presión de llenado y miccional) se realizó bajo anestesia antes de cada procedimiento quirúrgico: basal, con vejiga reducida y con vejiga ampliada al momento del sacrificio. Resultados: Nueve conejos fallecieron antes del sacrificio. El modelo dereducción vesical fue efectivo. Grupo 1: En 14 animales, con colocistoplastia convencional la capacidad vesical aumentó una media del 62% y la acomodación un 141%. Grupo 2: En 13 animales, con colocistoplastia seromuscular la capacidad vesical aumentó un 17% y la acomodación un 38%. Conclusiones: En este modelo animal de «vejiga reducida», la evaluación urodinámica de la colocistoplastia seromuscular demuestra ser menos efectiva que la colocistoplastia convencional (AU)

[The spermatic venography in the treatment of varicocele in children]. / Importancia de la venografía espermática en el tratamiento del varicocele en la infancia.

Embolization of the left internal spermatic vein is an effective nonsurgical treatment for varicocele. We performed spermatic venography in 17 children, during embolization procedure, in the last 7 years. The venographic findings were: Reflux reno-spermatic in 14 children, Non reflux reno-spermatic in one, and two children were Mixed-reflux in both spermatic venous systems. Embolization therapy was done in 15 cases in the same act. At follow up there were successful in 11 children (74%) and persistence of varicocele in 4 cases (26%). Surgical treatment was applied primarily in 2 children and secondarily post-embolization failure in 4 cases. In this paper we address the mechanism of varicocele on basis of venographic findings, in order to determining the optimal treatment.

[Giant fetal ovarian cyst. Diagnosis and treatment]. / Quiste gigante de ovario fetal. Diagnóstico y tratamiento.

A case of a prenatally diagnosed fetal ovarian cyst is presented. The pregnancy was uneventful and the girl delivered by cesarean because of the size of the cyst. The cyst was removed by laparotomy on the day of the delivery and luteum ovarian cyst was the histologic diagnosis.

[Intestinal polyp of infrequent localization: presentation of 2 cases]. / Pólipo intestinal de localización infrecuente: presentación de dos casos.

Although intestinal polyposis it is quite a frequently clinical picture, there are some cases that deserve an special comment. The first infant was 50 days old and had an hamartomatous polyp implanted in jejunum. The second case was a five years old girl with a juvenile polyp implanted in the appendix's base. Authors describe clinical presentation, symtomatology and diagnostic steps taken in these patients with special emphasis in pathological study. Both were surgically treated and with satisfactory results.