Pop-off mechanisms as protective factors against chronic renal disease in children with posterior urethral valves. / Los fenómenos pop-off como factores protectores de enfermedad renal crónica en niños con válvulas de uretra posterior.

OBJECTIVE: To identify whether pop-off mechanisms act as protective factors against chronic or end-stage renal disease in patients with posterior urethral valves. MATERIALS AND METHODS: A retrospective cohort study of patients with posterior urethral valves treated at a tertiary care children's hospital was carried out. Demographic, clinical, analytical, and radiological variables were collected. Considered as pop-off mechanisms were: unilateral high-grade vesicoureteral reflux with ipsilateral renal dysplasia and without involvement of the contralateral kidney, urinoma, prenatal urinary ascites, large bladder diverticulum, and persistent urachus. Multiple logistic regression and multivariate Cox regression were used for statistical analysis. RESULTS: 70 patients undergoing posterior urethral valve surgery in our institution from 2010 to August 2020 were included. 14 (20%) had pop-off mechanisms and 56 (80%) did not. Pop-off mechanisms protected against developing chronic renal disease (0% vs. 27%; p = 0.03) and could protect against the need for renal replacement therapy (0% vs. 9%; p = 0.58). Nadir creatinine values (mg/dl) were predictors for the development of chronic renal disease (0.37 vs. 0.53; p < 0.0001) and the need for renal replacement therapy (0.38 vs. 1.21; p < 0.001). CONCLUSIONS: Pop-off mechanisms act as a protective factor against chronic renal disease in patients with posterior urethral valves. Nadir creatinine is a predictor of chronic renal disease and the need for renal replacement therapy. A larger sample size is needed to determine whether pop-off mechanisms protect against the need for renal replacement therapy.

OBJETIVOS: Identificar si los fenómenos pop-off actúan como factores protectores de enfermedad renal crónica o terminal en pacientes con válvulas de uretra posterior. MATERIAL Y METODOS: Estudio de cohortes retrospectivo de los pacientes con válvulas de uretra posterior tratados en un hospital infantil de tercer nivel. Se recogieron variables demográficas, clínicas, analíticas y radiológicas. Se consideraron fenómenos pop-off: reflujo vesicoureteral de alto grado unilateral con displasia renal ipsilateral y sin afectación del riñón contralateral, urinoma, ascitis urinaria prenatal, divertículo vesical grande y uraco persistente. Para el análisis estadístico se han utilizado regresiones logísticas múltiples y regresión de Cox multivariante. RESULTADOS: Se incluyeron 70 pacientes intervenidos de válvulas de uretra posterior y visitados en nuestro centro desde 2010 hasta agosto de 2020. Catorce (20%) presentaban fenómenos pop-off y 56 (80%) no. Los fenómenos pop-off fueron protectores para el desarrollo de enfermedad renal crónica (0 vs. 27%; p = 0,03) y podrían proteger de la necesidad de terapia renal sustitutiva (0 vs. 9%; p = 0,58). Los valores de creatinina nadir (mg/dl) fueron predictores de desarrollo de enfermedad renal crónica (0,37 vs. 0,53; p < 0,0001) y de necesidad de terapia renal sustitutiva (0,38 vs. 1,21; p < 0,001). CONCLUSIONES: Los fenómenos pop-off actúan como factor protector de enfermedad renal crónica en los pacientes con válvulas de uretra posterior. La creatinina nadir es un factor predictor de enfermedad renal crónica y de necesidad de terapia renal sustitutiva. Se necesita un tamaño de muestra mayor para determinar si los fenómenos pop-off protegen de la necesidad de terapia renal sustitutiva.

Los fenómenos pop-off como factores protectoresde enfermedad renal crónica en niños con válvulasde uretra posterior / Pop-off mechanisms as protective factors against chronic renal disease in children with posterior urethral valves

Objetivos: Identificar si los fenómenos pop-off actúan como factoresprotectores de enfermedad renal crónica o terminal en pacientes conválvulas de uretra posterior. Material y métodos: Estudio de cohortes retrospectivo de los pa-cientes con válvulas de uretra posterior tratados en un hospital infantil detercer nivel. Se recogieron variables demográficas, clínicas, analíticas yradiológicas. Se consideraron fenómenos pop-off: reflujo vesicoureteralde alto grado unilateral con displasia renal ipsilateral y sin afectación delriñón contralateral, urinoma, ascitis urinaria prenatal, divertículo vesicalgrande y uraco persistente. Para el análisis estadístico se han utilizadoregresiones logísticas múltiples y regresión de Cox multivariante. Resultados: Se incluyeron 70 pacientes intervenidos de válvulas deuretra posterior y visitados en nuestro centro desde 2010 hasta agostode 2020. Catorce (20%) presentaban fenómenos pop-off y 56 (80%)no. Los fenómenos pop-off fueron protectores para el desarrollo deenfermedad renal crónica (0 vs. 27%; p = 0,03) y podrían proteger de lanecesidad de terapia renal sustitutiva (0 vs. 9%; p = 0,58). Los valores decreatinina nadir (mg/dl) fueron predictores de desarrollo de enfermedadrenal crónica (0,37 vs. 0,53; p < 0,0001) y de necesidad de terapia renalsustitutiva (0,38 vs. 1,21; p < 0,001). Conclusiones: Los fenómenos pop-off actúan como factor protectorde enfermedad renal crónica en los pacientes con válvulas de uretraposterior. La creatinina nadir es un factor predictor de enfermedad renalcrónica y de necesidad de terapia renal sustitutiva. Se necesita un tamañode muestra mayor para determinar si los fenómenos pop-off protegende la necesidad de terapia renal sustitutiva.(AU)

Objective: To identify whether pop-off mechanisms act as protec-tive factors against chronic or end-stage renal disease in patients withposterior urethral valves. Materials and methods: A retrospective cohort study of patients withposterior urethral valves treated at a tertiary care children’s hospital wascarried out. Demographic, clinical, analytical, and radiological variableswere collected. Considered as pop-off mechanisms were: unilateral high-grade vesicoureteral reflux with ipsilateral renal dysplasia and withoutinvolvement of the contralateral kidney, urinoma, prenatal urinary ascites,large bladder diverticulum, and persistent urachus. Multiple logistic regres-sion and multivariate Cox regression were used for statistical analysis. Results: 70 patients undergoing posterior urethral valve surgery inour institution from 2010 to August 2020 were included. 14 (20%) hadpop-off mechanisms and 56 (80%) did not. Pop-off mechanisms pro-tected against developing chronic renal disease (0% vs. 27%; p = 0.03)and could protect against the need for renal replacement therapy (0%vs. 9%; p = 0.58). Nadir creatinine values (mg/dl) were predictors forthe development of chronic renal disease (0.37 vs. 0.53; p < 0.0001)and the need for renal replacement therapy (0.38 vs. 1.21; p < 0.001). Conclusions: Pop-off mechanisms act as a protective factor againstchronic renal disease in patients with posterior urethral valves. Nadircreatinine is a predictor of chronic renal disease and the need for renalreplacement therapy. A larger sample size is needed to determine whetherpop-off mechanisms protect against the need for renal replacement therapy.(AU)

Advantages of endoscopic pilonidal sinus treatment. / Ventajas de la cirugía endoscópica para el tratamiento quirúrgico del sinus pilonidal.

INTRODUCTION: Classic treatment of pilonidal sinus is associated with a high rate of complications and a long and painful postoperative period requiring daily wound care, with a decrease in patients' quality of life. The objective of our study was to evaluate the effectiveness and advantages of the endoscopic technique vs. conventional surgery of pilonidal sinus in the pediatric population. METHODS: A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution in 2019. Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) were compared. The surgical technique chosen was surgeon-dependent. RESULTS: 49 patients were studied - 14 undergoing PEPSiT, 23 undergoing EHSI, and 12 undergoing EPC. Full healing process was faster in PEPSiT than in EHSI (11 weeks earlier; 95% CI: 6.2-15.9; p < 0.001). Pain on the Visual Analogue Scale (VAS) and need for analgesics were less in the PEPSiT group (p = 0.001). Mean time to return to normal life was shorter with PEPSiT - 78 days earlier than EHSI (95% CI: 42.2-114.9; p < 0.001) and 39 days earlier than EPC (95% CI: -2.5-81.4; p = 0.06). No complications were recorded with PEPSiT, whereas complication rate with EHSI was 69.6%, and complication rate with EPC was 58.3% (p = 0.001). CONCLUSIONS: Endoscopic pilonidal sinus treatment is effective, with a short and painless postoperative period, and easy wound care. It allows for an early return to normal life without restrictions.

INTRODUCCION: Los procedimientos clásicos exeréticos en el tratamiento del sinus pilonidal están relacionados con una alta tasa de complicaciones y conllevan un postoperatorio largo y doloroso, precisando curas tópicas diarias hasta la cicatrización completa, lo que provoca una disminución de la calidad de vida de los pacientes. El objetivo de este trabajo es evaluar la eficacia y las ventajas de la técnica endoscópica frente a la cirugía convencional del sinus pilonidal en población pediátrica. METODOS: Estudio cuasi-experimental en pacientes pediátricos operados de sinus pilonidal durante 2019 en un único centro. Comparamos la exéresis con cicatrización por segunda intención (ESI), exéresis con cierre primario (ECP) y PEPSiT (Pediatric Endoscopic Pilonidal Sinus Treatment). La elección de la técnica fue cirujano-dependiente. RESULTADOS: Se estudiaron 49 pacientes: 14 PEPSiT, 23 ESI y 12 ECP. Se consigue la epitelización completa 11 semanas antes con PEPSiT que con ESI (IC95%: 6,3 a 16,3; p < 0,001). Encontramos menor dolor en escala analógica visual (EVA) con PEPSiT, y paralelamente también necesitaban menos analgésicos (p = 0,001). Con PEPSiT recuperan su vida normal 78 días antes de media que los ESI (IC95%: 42,2 a 114,9; p < 0,001) y 39 días antes que ECP (IC95%: -2,5 a 81,4; p = 0,06). No se registraron complicaciones con PEPSiT frente a un 69,6% con ESI y 58,3% con ECP (p = 0,001). CONCLUSIONES: El tratamiento endoscópico del sinus pilonidal es efectivo, con un postoperatorio corto, indoloro y con fáciles cuidados. Permite la rápida recuperación de la actividad normal sin las restricciones que conlleva la cirugía convencional.

Ventajas de la cirugía endoscópica para el tratamiento quirúrgico del sinus pilonidal / Advantages of endoscopic pilonidal sinus treatment

Introducción: Los procedimientos clásicos exeréticos en el tratamiento del sinus pilonidal están relacionados con una alta tasa de complicaciones y conllevan un postoperatorio largo y doloroso, precisandocuras tópicas diarias hasta la cicatrización completa, lo que provoca unadisminución de la calidad de vida de los pacientes. El objetivo de este trabajo es evaluar la eficacia y las ventajas de la técnica endoscópica frentea la cirugía convencional del sinus pilonidal en población pediátrica. Métodos: Estudio cuasi-experimental en pacientes pediátricos operados de sinus pilonidal durante 2019 en un único centro. Comparamosla exéresis con cicatrización por segunda intención (ESI), exéresis concierre primario (ECP) y PEPSiT (Pediatric Endoscopic Pilonidal SinusTreatment). La elección de la técnica fue cirujano-dependiente. Resultados: Se estudiaron 49 pacientes: 14 PEPSiT, 23 ESI y 12ECP. Se consigue la epitelización completa 11 semanas antes con PEP-SiT que con ESI (IC95%: 6,3 a 16,3; p < 0,001). Encontramos menordolor en escala analógica visual (EVA) con PEPSiT, y paralelamentetambién necesitaban menos analgésicos (p = 0,001). Con PEPSiT recuperan su vida normal 78 días antes de media que los ESI (IC95%: 42,2a 114,9; p < 0,001) y 39 días antes que ECP (IC95%: -2,5 a 81,4; p =0,06). No se registraron complicaciones con PEPSiT frente a un 69,6%con ESI y 58,3% con ECP (p = 0,001). Conclusiones: El tratamiento endoscópico del sinus pilonidal esefectivo, con un postoperatorio corto, indoloro y con fáciles cuidados.Permite la rápida recuperación de la actividad normal sin las restricciones que conlleva la cirugía convencional.(AU)

Introduction: Classic treatment of pilonidal sinus is associatedwith a high rate of complications and a long and painful postoperativeperiod requiring daily wound care, with a decrease in patients’ qualityof life. The objective of our study was to evaluate the effectiveness andadvantages of the endoscopic technique vs. conventional surgery ofpilonidal sinus in the pediatric population. Methods: A quasi-experimental study was carried out in pediatricpatients undergoing pilonidal sinus surgery at a single institution in2019. Excision and healing by secondary intention (EHSI), excisionand primary closure (EPC), and Pediatric Endoscopic Pilonidal SinusTreatment (PEPSiT) were compared. The surgical technique chosenwas surgeon-dependent. Results: 49 patients were studied – 14 undergoing PEPSiT, 23undergoing EHSI, and 12 undergoing EPC. Full healing process wasfaster in PEPSiT than in EHSI (11 weeks earlier; 95% CI: 6.2-15.9; p< 0.001). Pain on the Visual Analogue Scale (VAS) and need for analgesics were less in the PEPSiT group (p = 0.001). Mean time to returnto normal life was shorter with PEPSiT – 78 days earlier than EHSI(95% CI: 42.2-114.9; p < 0.001) and 39 days earlier than EPC (95%CI: -2.5-81.4; p = 0.06). No complications were recorded with PEPSiT,whereas complication rate with EHSI was 69.6%, and complication ratewith EPC was 58.3% (p = 0.001). Conclusions: Endoscopic pilonidal sinus treatment is effective, witha short and painless postoperative period, and easy wound care. It allowsfor an early return to normal life without restrictions.(AU)

Our experience with laparoscopic Anderson-Hynes ureteropyeloplasty. / Ureteropieloplastia Anderson-Hynes laparoscópica en niños. Nuestra experiencia.

OBJECTIVE: To analyze whether the application of laparoscopic surgery in the treatment of pyeloureteral junction obstruction (PUJO) has been beneficial for pediatric patients. MATERIALS AND METHODS: Medical records of all patients undergoing PUJO surgery from January 1997 to December 2017 were retrospectively reviewed. Patients with <6-month follow-up and patients undergoing video-assisted surgery were excluded. Open surgery was compared with laparoscopic surgery. The following data were collected: surgical approach, need for and type of urinary diversion, operating time, mean hospital stay, complications, and restenosis rate. Ultrasound and diuretic renogram parameters were also retrieved. RESULTS: 328 Anderson-Hynes pyeloplasties were analyzed, 142 of which had been performed laparoscopically. Overall success rate was 96.6%, and complication rate was 11.9%. No significant differences were noted between open and laparoscopic surgery. In 97.5% of surgeries, urine was diverted using an external nephroureteral catheter, a double J stent, or a Salle stent, with significant differences between open and laparoscopic surgery. Mean operating time was significantly longer in laparoscopic surgery. Mean hospital stay was significantly shorter in the laparoscopic surgery group. CONCLUSION: Surgical approach does not play a role in PUJO surgery success. Therefore, in our view, laparoscopic surgery should be the technique of choice in pediatric patients.

OBJETIVO: Analizar si la aplicación de la cirugía laparoscópica en el tratamiento de la estenosis pieloureteral (EPU) han sido beneficiosos para el paciente pediátrico. MATERIAL Y METODO: Hemos revisado de forma retrospectiva las historias clínicas de todos aquellos pacientes intervenidos de EPU desde enero 1997 hasta diciembre 2017. Se excluyeron las que tuvieron seguimiento menor a 6 meses, y las cirugías videoasistidas. Se han comparado la cirugía abierta con la cirugía laparoscópica. Se han recogido los siguientes datos: abordaje quirúrgico, necesidad y tipo de derivación urinaria, tiempo quirúrgico, estancia media, complicaciones, tasa de reestenosis. Los parámetros ecográficos y del renograma diurético también han sido recogidos. RESULTADOS: Se han analizado 328 pieloplastias, 142 se realizaron laparoscópicamente. La tasa de éxito global ha sido del 96,6%, existiendo un 11,9% de complicaciones; sin existir diferencias significativas entre la cirugía abierta y la laparoscópica. En el 97,5% de las cirugías, la orina se derivó mediante catéter nefroureteral externo, catéter doble J o catéter tipo Salle; existiendo diferencias entre cirugía abierta y laparoscópica. El tiempo quirúrgico medio fue significativamente superior en la cirugía laparoscópica. La estancia media fue menor en el grupo de cirugía laparoscópica de forma significativa. CONCLUSION: La vía de abordaje no es un factor que influya en el éxito de la cirugía de la EPU, por ello pensamos que la cirugía laparoscópica es la técnica de elección en pacientes pediátricos.

Ureteropieloplastia Anderson-Hynes laparoscópica en niños. Nuestra experiencia / Our experience with laparoscopic Anderson-Hynes ureteropyeloplasty

OBJETIVO: Analizar si la aplicación de la cirugía laparoscópica en el tratamiento de la estenosis pieloureteral (EPU) ha sido beneficiosa para el paciente pediátrico. MATERIAL Y MÉTODO: Hemos revisado de forma retrospectiva las historias clínicas de todos aquellos pacientes intervenidos de EPU desde enero de 1997 hasta diciembre de 2017. Se excluyeron las que tuvieron seguimiento menor a 6 meses, y las cirugías videoasistidas. Se han comparado la cirugía abierta con la cirugía laparoscópica. Se han recogido los siguientes datos: abordaje quirúrgico, necesidad y tipo de derivación urinaria, tiempo quirúrgico, estancia media, complicaciones, tasa de reestenosis. Los parámetros ecográficos y del renograma diurético también han sido recogidos. RESULTADOS: Se han analizado 328 pieloplastias, 142 se realizaron laparoscópicamente. La tasa de éxito global ha sido del 96,6%, existiendo un 11,9% de complicaciones, sin existir diferencias significativas entre la cirugía abierta y la laparoscópica. En el 97,5% de las cirugías, la orina se derivó mediante catéter nefroureteral externo, catéter doble J o catéter tipo Salle, existiendo diferencias entre cirugía abierta y laparoscópica. El tiempo quirúrgico medio fue significativamente superior en la cirugía laparoscópica. La estancia media fue menor en el grupo de cirugía laparoscópica de forma significativa. CONCLUSIÓN: La vía de abordaje no es un factor que influya en el éxito de la cirugía de la EPU, por ello pensamos que la cirugía laparoscópica es la técnica de elección en pacientes pediátricos

OBJECTIVE: To analyze whether the application of laparoscopic surgery in the treatment of pyeloureteral junction obstruction (PUJO) has been beneficial for pediatric patients. MATERIALS AND METHODS: Medical records of all patients undergoing PUJO surgery from January 1997 to December 2017 were retrospectively reviewed. Patients with < 6-month follow-up and patients undergoing video-assisted surgery were excluded. Open surgery was compared with laparoscopic surgery. The following data were collected: surgical approach, need for and type of urinary diversion, operating time, mean hospital stay, complications, and restenosis rate. Ultrasound and diuretic renogram parameters were also retrieved. RESULTS: 328 Anderson-Hynes pyeloplasties were analyzed, 142 of which had been performed laparoscopically. Overall success rate was 96.6%, and complication rate was 11.9%. No significant differences were noted between open and laparoscopic surgery. In 97.5% of surgeries, urine was diverted using an external nephroureteral catheter, a double J stent, or a Salle stent, with significant differences between open and laparoscopic surgery. Mean operating time was significantly longer in laparoscopic surgery. Mean hospital stay was significantly shorter in the laparoscopic surgery group. CONCLUSION: Surgical approach does not play a role in PUJO surgery success. Therefore, in our view, laparoscopic surgery should be the technique of choice in pediatric patients

Randomized clinical trial between polyacrylate-polyalcohol copolymer (PPC) and dextranomer-hyaluronic acid copolymer (Dx/HA) as bulking agents for endoscopic treatment of primary vesicoureteral reflux (VUR).

OBJECTIVE: To compare the radiological and clinical outcomes of endoscopic treatment of primary VUR using polyacrylate-polyalcohol copolymer (PPC-Vantris®) or dextranomer-hyaluronic acid copolymer (Dx/HA-Deflux®). MATERIALS AND METHODS: From October 2014 to April 2017, patients with primary VUR grade III to V that needed endoscopic treatment (ET) were eligible for this randomized clinical trial. We excluded toilet-trained patients with lower urinary tract symptoms. Patients were randomized and allocated into two groups: PPC group and Dx/HA group. After endoscopic treatment a voiding cystourethrography (VCUG) was performed at 6 months; if VUR was still present a second ET was performed. Radiological success was considered if postoperative VUR grade was 0 and clinical success rate was considered if no more fUTI appeared during follow-up. RESULTS: Forty-six patients were eligible but 2 did not accept the trial. Forty-four patients with 73 refluxing ureters were included. PPC: 34 refluxing ureters; and Dx/HA: 39 refluxing ureters. Both groups were statistically homogeneous and comparable. Mean follow-up was 27.6 months. Radiological success rate (82.2%) and clinical success rate (92.3%) were similar in both groups (p > 0.05). The volume of bulking agent used in those successfully treated was greater in Dx/HA group (p < 0.05). Distal ureter was excise in all cases of ureteral reimplantation after PPC treatment; however, distal ureter was preserved in all ureters reimplanted after Dx/HA injection. CONCLUSION: PPC and Dx/HA had similar outcomes, but we must warn that ureteral reimplantation after endoscopic treatment with PPC is difficult because of the periureteral fibrosis.

Anal canal duplication and triplication: a rare entity with different presentations.

Anal canal duplication (ACD) is the rarest of gastrointestinal duplications. Few cases have been reported. Most cases present as an opening in the midline, posterior to the normal anus. The aim of our revision is to contribute with eight new cases, some of them with unusual presentations: five presented as the typical form, one with a perianal nodule, and two presented as two separate orifices (anal canal triplication). Complete excision was performed in all patients with no complications. ACD is the most distal and the least frequent digestive duplication. Its treatment should be surgical excision, to avoid complications such as abscess, fistulization, or malignization. Anal canal triplication has never been described before.

¿Es necesario realizar una cistouretrografía miccional seriada (CUMS) tardía tras el tratamiento endoscópico exitoso inicial con copolímero de dextranómreo/ácido hialurónico (Dx/HA) para el reflujo vesicoureteral (RVU)? / Routine delayed voiding cystourethography after initial successful endoscopic treatment with Dextranomer/Hialuronic Acid Copolimer (Dx/HA) of vesicoureteral reflux (VUR). Is it necessary?

Introducción: La mayoría de las guías recomiendan realizar una cistografía miccional (CUMS) temprana tras el tratamiento endoscópico del reflujo vesicoureteral (RVU), pero no hay consenso sobre cómo hacer el seguimiento a largo plazo en este grupo de pacientes. El objetivo de este estudio es analizar si es necesaria la realización de una CUMS tardía en aquellos pacientes tratados con éxito. Material y método: Hemos revisado las historias clínicas de aquellos pacientes tratados de RVU con el copolímero de dextranómero/ácido hialurónico (Dx/AH) desde 2006 a 2010. Se han seleccionado aquellos pacientes que estaban curados tras el tratamiento con más de 3 años de seguimiento y control cistográfico tardío. Hemos analizado los hallazgos clínicos y radiológicos a largo plazo. Resultados: Ciento sesenta niños con 228 uréteres refluyentes recibieron tratamiento con Dx/AH con un seguimiento medio de 52,13 meses. A 215 se les realizó CUMS de forma temprana, siendo la tasa de éxito del 84,1%. El grupo de estudio fueron 94/215 uréteres refluyentes que tuvieron un seguimiento clínico y cistográfico tardío mayor de 3 años. En el 79,8% la CUMS mostró ausencia de RVU, siendo la tasa de éxito tardío clínico del 91,7%. La incidencia de infección del tracto urinario febril entre aquellos que estaban curados desde el punto de vista radiológico frente a aquellos en los que recidivó el RVU fue del 8 y 15%, respectivamente. Solo existieron diferencias significativas en la recidiva del RVU entre aquellos uréteres que se habían tratado de forma inicial con una punción o con 2 punciones de Dx/AH. Conclusión: Si el objetivo del tratamiento del RVU es disminuir las infecciones del tracto urinario febril, no es necesario realizar una CUMS tardía tras un tratamiento exitoso inicial con Dx/AH, a pesar de que la tasa de éxito radiológico es menor que la del clínico

Introduction: Some guidelines recommend an early voiding cystourethrography (VCUG) after endoscopic treatment of vesicoureteral reflux (VUR), but there's no consensus if it's necessary a long-term follow-up in these patients. The aim of our study is analyze if it's necessary a delayed VCUG after initial successful treatment with Dx/HA. Material and method: We have reviewed all medical charts of patients that underwent Dx/HA treatment from 2006 to 2010. We have selected patients with initial successful treatment and more than 3 years of radiological and clinical follow-up. We have analyzed late clinical and radiological outcomes. Results: One hundred and sixty children with 228 refluxing ureters underwent Dx/HA endoscopic treatment with a mean follow-up of 52.13 months. Early VCUG was performed in 215 ureters with an initial successful rate of 84.1%. The group of study was 94/215 ureters with more than 3 years of follow-up with a delayed VCUG. VUR was still resolved in 79,8% of the ureters. Clinical success rate was 91.7%. The incidence of febrile urinary tract infection in those patients with cured VUR and those with a relapsed VUR was 8 and 15%, respectively; but there were no significant differences. We have not found any variable related with relapsed VUR except those ureters that initially received 2 injections (P < .05). Conclusion: If our objective in the treatment of VUR is to reduce the incidence of febrile urinary tract infection it is not necessary to perform a delayed VCUG even though the long-term radiological outcomes is worse than clinical outcome

Routine delayed voiding cystourethography after initial successful endoscopic treatment with Dextranomer/Hialuronic Acid Copolimer (Dx/HA) of vesicoureteral reflux (VUR). Is it necessary? / ¿Es necesario realizar una cistouretrografía miccional seriada (CUMS) tardía tras el tratamiento endoscópico exitoso inicial con copolímero de dextranómreo/ácido hialurónico (Dx/HA) para el reflujo vesicoureteral (RVU)?

INTRODUCTION: Some guidelines recommend an early voiding cystourethrography (VCUG) after endoscopic treatment of vesicoureteral reflux (VUR), but there's no consensus if it's necessary a long-term follow-up in these patients. The aim of our study is analyze if it's necessary a delayed VCUG after initial successful treatment with Dx/HA. MATERIAL AND METHOD: We have reviewed all medical charts of patients that underwent Dx/HA treatment from 2006 to 2010. We have selected patients with initial successful treatment and more than 3 years of radiological and clinical follow-up. We have analyzed late clinical and radiological outcomes. RESULTS: One hundred and sixty children with 228 refluxing ureters underwent Dx/HA endoscopic treatment with a mean follow-up of 52.13 months. Early VCUG was performed in 215 ureters with an initial successful rate of 84.1%. The group of study was 94/215 ureters with more than 3 years of follow-up with a delayed VCUG. VUR was still resolved in 79,8% of the ureters. Clinical success rate was 91.7%. The incidence of febrile urinary tract infection in those patients with cured VUR and those with a relapsed VUR was 8 and 15%, respectively; but there were no significant differences. We have not found any variable related with relapsed VUR except those ureters that initially received 2 injections (P<.05). CONCLUSION: If our objective in the treatment of VUR is to reduce the incidence of febrile urinary tract infection it is not necessary to perform a delayed VCUG even though the long-term radiological outcomes is worse than clinical outcome.

[Left cardiac sympathetic denervation in congenital ventricular arrythmias: initial experience]. / Denervación cardiaca simpática izquierda en las arritmias ventriculares congénitas: experiencia inicial.

BACKGROUND: Left cardiac sympathetic denervation (LCSD) has been proposed as a second-line therapy for potentially lethal ventricular arrythmia with no response to the gold standard treatment with beta-blockers. It has been used mainly in channelopathies such as long QT syndrome (LQTS) and polymorphic cathecolaminergic ventricular tachycardia (PCVT). AIM: Analizing our preliminary experience in the treatment of congenital ventricular arrythmia with thoracoscopic LCSD. MATERIAL AND METHODS: We have reviewed the first 5 LCSD performed in the last two years (2011-2013) to 5 female patients with a mean age of 8 years (1 month-15 years). The underlying disease was the LQTS in three and the PCVT in two. RESULTS: Selective contralateral bronchial intubation was used in two cases and double-lumen tube in three. We performed in all cases T1 sympathicolysis, denervation of T2 ganglion and sympathicolysis of T3 and T5 levels. No intraoperatory nor postoperatory complications were observed. In four cases ventricular tachycardia disappeared after the procedure and in one case, although they did not completely disappeared, they could be better controled on medical therapy. Ventricular extrasystoles reappeared 17 months after the procedure in one PCTV case, but disappeared completely after T1-T5 left sympathectomy completion. With a mean follow-up time of 20 months, all patients are sympthom-free and continue on betablocker oral therapy. CONCLUSIONS: Thoracoscopic DCSI is a safe and effective therapy for prevention of severe congenital ventricular arrythmias.

INTRODUCCION: La denervación cardiaca simpática izquierda (DCSI) se ha propuesto como tratamiento de segunda línea de las arritmias ventriculares con potencial riesgo de muerte que no responden al tratamiento farmacológico gold standard con beta bloqueantes. Fundamentalmente se ha utilizado en las canalopatías, que incluyen el síndrome de QT largo congénito (SQTL) y la taquicardia ventricular polimórfica catecolaminérgica (TVPC). OBJERIVO: Analizar nuestra experiencia inicial en el tratamiento de las arritmias ventriculares congénitas mediante DCSI toracoscópica. MATERIAL Y METODOS: Hemos revisado las primeras 5 DCSI realizadas en los últimos dos años (2011-2013) a 5 pacientes femeninas con una edad media de 8 años (1 mes-15 años). La patología de base fue el SQTL en tres casos y la TVPC en dos. Se utilizó una intubación selectiva contralateral en dos casos y una intubación con tubo de doble luz en tres. En todos los casos se realizó simpaticolisis T1, denervación del ganglio T2 y simpaticolisis de los niveles T3 y T5. RESULTADOS: No se registraron complicaciones intra ni postoperatorias. En 4 casos las taquicardias ventriculares desparecieron tras el procedimiento y en un caso, pese a no desaparecer completamente, se controlaron adecuadamente con tratamiento médico. Un caso de TVPC presentó nuevamente salvas de extrasístoles ventriculares (EV) 17 meses después de la simpaticolisis, realizando una simpatectomía T1-T5 con desaparición de las EV. Con un seguimiento medio de 20 meses, todas las pacientes permanecen asintomáticas y reciben tratamiento betabloqueante oral. CONCLUSIONES: La DCSI vía toracoscópica es un tratamiento efectivo y seguro para la prevención de las arritmias ventriculares congénitas graves.

Denervación cardiaca simpática izquierda en las arritmias ventriculares congénitas: experiencia inicial / Left cardiac sympathetic denervation in congenital ventricular arrythmias: initial experience

Introducción. La denervación cardiaca simpática izquierda (DCSI) se ha propuesto como tratamiento de segunda línea de las arritmias ventriculares con potencial riesgo de muerte que no responden al tratamiento farmacológico gold standard con beta bloqueantes. Fundamentalmente se ha utilizado en las canalopatías, que incluyen el síndrome de QT largo congénito (SQTL) y la taquicardia ventricular polimórfica catecolaminérgica (TVPC).Objetivo. Analizar nuestra experiencia inicial en el tratamiento de las arritmias ventriculares congénitas mediante DCSI toracoscópica. Material y métodos. Hemos revisado las primeras 5 DCSI realizadas en los últimos dos años (2011-2013) a 5 pacientes femeninas con una edad media de 8 años (1 mes-15 años). La patología de base fue el SQTL en tres casos y la TVPC en dos. Se utilizó una intubación selectiva contralateral en dos casos y una intubación con tubo de doble luz en tres. En todos los casos se realizó simpaticolisis T1, denervación del ganglio T2 y simpaticolisis de los niveles T3 y T5.Resultados. No se registraron complicaciones intra ni postoperatorias. En 4 casos las taquicardias ventriculares desparecieron tras el procedimiento y en un caso, pese a no desaparecer completamente, se controlaron adecuadamente con tratamiento médico. Un caso de TVPC presentó nuevamente salvas de extrasístoles ventriculares (EV) 17 me-ses después de la simpaticolisis, realizando una simpatectomía T1-T5 con desaparición de las EV. Con un seguimiento medio de 20 meses, todas las pacientes permanecen asintomáticas y reciben tratamiento betabloqueante oral. Conclusiones: La DCSI vía toracoscópica es un tratamiento efectivo y seguro para la prevención de las arritmias ventriculares congénitas graves

Background. Left cardiac sympathetic denervation (LCSD) has been proposed as a second-line therapy for potentially lethal ventricular arrythmia with no response to the gold standard treatment with beta-blockers. It has been used mainly in channelopathies such as long QT syndrome (LQTS) and polymorphic cathecolaminergic ventricular tachycardia (PCVT).Aim. Analizing our preliminary experience in the treatment of congenital ventricular arrythmia with thoracoscopic LCSD. Material and methods. We have reviewed the first 5 LCSD performed in the last two years (2011-2013) to 5 female patients with a mean age of 8 years (1 month-15 years). The underlying disease was the LQTS in three and the PCVT in two. Results. Selective contralateral bronchial intubation was used in two cases and double-lumen tube in three. We performed in all cases T1 sympathicolysis, denervation of T2 ganglion and sympathicolysis of T3 and T5 levels. No intraoperatory nor postoperatory complications were observed. In four cases ventricular tachycardia disappeared after the procedure and in one case, although they did not completely disappeared, they could be better controled on medical therapy. Ventricular extrasystoles reappeared 17 months after the procedure in one PCTV case, but disappeared completely after T1-T5 left sympathectomy completion. With a mean follow-up time of 20 months, all patients are sympthom-free and continue on betablocker oral therapy. Conclusions: Thoracoscopic DCSI is a safe and effective therapy for prevention of severe congenital ventricular arrythmias

Manejo del traumatismo rectal en la edad pediátrica / Management of rectal traumatism in the pediatric age

Objetivo. En pediatría, las heridas anorrectales son infrecuentes y su manejo ha incluido clásicamente la derivación intestinal. Actualmente, y si las condiciones son favorables, se tiende a realizar una reparación primaria de la lesión sin colostomía. Presentamos nuestra casuística y experiencia en el manejo de esta patología, revisando la literatura con el objetivo de crear unas pautas de actuación a seguir en estos casos. Material y métodos. Estudio retrospectivo, descriptivo, de pacientes con herida anorrectal en nuestro centro entre 2005-2011. Se analizan los datos demográficos de cada paciente, mecanismo de la lesión, malformaciones asociadas, tiempo de evolución lesión-cirugía, tratamiento, estancia hospitalaria y evolución. Resultados. Los 7 pacientes revisados se clasifican según el tipo de lesión en dos grupos; lesiones iatrogénicas (todas con malformaciones asociadas) y lesiones accidentales no iatrogénicas. En 4 de ellos se realizó una TC (tomografía computerizada). Ninguno se exploró mediante sigmoidoscopia. En los pacientes revisados, se realizó colostomía de (..) (AU)

Objective. In pediatrics anorectal injuries are not very common and their management classically includes an intestinal derivation. In selected patients and with favourable conditions, there has been an increased interest in repair the injuries without derivation. We presentour experience in the management of this pathology, looking through the literature. The aim of the study is to develop some guidelines to follow in these cases. Patients and methods. Retrospective and descriptive study of patients with anorectal injury admitted in our institution between 2005-2011. Data abstraction included patient demographic data, mechanism of injury, associated injuries, time between injury and treatment, methods of diagnosis, treatment, length of stay and resultant complications. Results. 7 patients were reviewed and classified according to the type of the injury in two groups: iatrogenic injuries (all of them with (..) (AU)

[Anderson-Hynes pyeloplasty in children under 2 years. Is the laparoscopy the technique of choice?]. / Pieloplastia Anderson-Hynes en menores de 2 años. ¿Es la laparoscopia la técnica de elección?

OBJECTIVE: To analyze if the laparoscopic pyeloplasty is as effective as the open procedure in the ureteropelvic junction obstruction in patients under 2 years of age. PATIENTS AND METHODS: Pyeloplasties performed in children under 2 years of age between 2007 and 2010. Weight, pre and postoperative renal pelvis and calices diameter, operating time, hospital stay and complications were analyzed. RESULTS: We found no statistic differences in weight, complications, or pre and postoperative renal pelvis and calices diameter. However, we found differences in hospital stay and operating time (p<0.05). CONCLUSIONS: Laparoscopic pyeloplasty in children under 2 years of age is a good alternative technique for ureteropelvic junction obstruction, although operating time are still long.

Pieloplastia Anderson-Hynes en menores de 2 años. ¿Es la laparoscopia la técnica de elección? / Anderson hynes pyeloplasty in children under 2 years. is the laparoscopy the technique of choice?

Objetivo. Demostrar que la laparoscopia es tan eficaz como la cirugía abierta en el tratamiento de la estenosis pieloureteral en menores de 2 años. Material y métodos. Pieloplastias en menores de 2 años entre 2007y 2010. Dos grupos: pieloplastia abierta (PA) y pieloplastia laparoscópica(PLap). Se han analizado: peso, diámetro de la pelvis renal y delos cálices pre y postoperatorios, tiempos quirúrgicos, estancia media y complicaciones. Resultados. 35 PA y 13 PLap. No han existido diferencias significativas ni en el peso medio, ni en los diámetros de la pelvis renal y cálices pre ni postoperatorios, ni en las complicaciones. Sí hemos encontrado diferencias estadísticamente significativas en el tiempo quirúrgico medio y la estancia media (p<0,05).Conclusión. Este estudio sugiere que la pieloplastia laparoscópica en niños menores de 2 años es una buena técnica alternativa a la cirugía abierta. El único inconveniente es el mayor tiempo quirúrgico, que irá disminuyendo con la experiencia (AU)

Objective. To analyze if the laparoscopic pyeloplasty is as effective as the open procedure in the ureteropelvic junction obstruction inpatients under 2 years of age. Patients and methods. Pyeloplasties performed in children under2 years of age between 2007 and 2010. Weight, pre and postoperative renal pelvis and calices diameter, operating time, hospital stay and complications were analyzed. Results. We found no statistic differences in weight, complications, or pre and postoperative renal pelvis and calices diameter. However, we found differences in hospital stay and operating time (p<0.05).Conclusions. Laparoscopic pyeloplasty in children under 2 years of age is a good alternative technique for ureteropelvic junction obstruction, although operating time are still long (AU)

[Management of rectal traumatism in the pediatric age]. / Manejo del traumatismo rectal en la edad pediátrica.

OBJECTIVE: In pediatrics anorectal injuries are not very common and their management classically includes an intestinal derivation. In selected patients and with favourable conditions, there has been an increased interest in repair the injuries without derivation. We present our experience in the management of this pathology, looking through the literature. The aim of the study is to develop some guidelines to follow in these cases. PATIENTS AND METHODS: Retrospective and descriptive study of patients with anorectal injury admitted in our institution between 2005-2011. Data abstraction included patient demographic data, mechanism of injury, associated injuries, time between injury and treatment, methods of diagnosis, treatment, length of stay and resultant complications. RESULTS: 7 patients were reviewed and classified according to the type of the injury in two groups: iatrogenic injuries (all of them with associated malformations) and non-iatrogenic accidental injuries. A CT was performed in 4 cases. None of them was explored with sigmoidoscopy. We performed colostomy without primary repair in four patients, primary injury repair with colostomy in two patients, and one patient underwent primary repair without colostomy. All patients had a long evolution (mean hospital length of stay was 31,4 days) with many dressings and some of them required relaparotomy. Fecal continence and long term results have been, in all of them, satisfactories. CONCLUSIONS: An early and complete diagnosis of anorectal injuries is basic for an appropriate approach to the treatment. Primary repair of injuries without colostomy could be a safe procedure as a first treatment in selected patients: stables, with no contamination and no associated injuries. It is very important to individualize each patient to minimize the morbidity, reduce the hospital length of stay and reach a full continence.

[Laparoscopìc pyeloplasty in pediatric patients. Our initial cases and lessons learned]. / Pieloplastia laparoscópica en pacientes pediátricos. Nuestros primeros casos y lecciones aprendidas.

OBJECTIVE: To analyze the initial experience in our first patients with ureteropelvic junction obstruction (UPJO) treated by laparoscopic surgery. PATIENTS AND METHODS: All laparoscopic Anderson-Hynes pyeloplasties performed from July 2007 to April 2009 were analyzed. Before surgery, patients underwent a renal ultrasound and isotope renogram. A double J catheter was left in place and subsequently removed. Patients were followed up by ultrasound and renography. RESULTS: Fourteen patients with a median age of 8.6 years were analyzed. Preoperative ultrasound showed a median renal pelvis diameter of 34.5 mm. Median operating time was 235 min, and median hospital stay 5.5 days. Median renal pelvis diameter decreased in all patients (13.5 mm). CONCLUSIONS: Laparoscopy is an effective procedure for UPJO correction in children, although operating times are still long.

Pieloplastia laparoscópica en pacientes pediátricos. Nuestros primeros casos y lecciones aprendidas / Laparoscopìc pyeloplasty in pediatric patients. Our initial cases and lessons learned

Objetivo: Analizar la experiencia inicial en nuestros primeros pacientes afectos de estenosis pieloureteral tratados mediante cirugía laparoscópica. Pacientes y métodos: Se han incluido todas las pieloplastias laparoscópicas tipo Andereson Hynes realizadas entre julio de 2007 y abril de 2009. Los pacientes fueron estudiados preoperatoriamente mediante ecografía renal, renograma isotópico. Se les dejó un tutor doble «J» que se retiró posteriormente. El seguimiento ha sido ecográfico y renográfico. Resultados: Catorce pacientes con una media de edad de 8,6 años El estudio ecográfico prequirúrgico mostró una media del diámetro de la pelvis renal de 34,5mm. El tiempo quirúrgico media ha sido de 235min. La estancia media fue de 5,5 días. En todos los pacientes ha habido una disminución de la media del diámetro de la pelvis renal (13,5mm). Conclusiones: La laparoscopia es técnica eficaz para la corrección de la estenosis pieloureteral en la edad pediátrica; a pesar que los tiempos quirúrgicos aún son elevados (AU)

Objective: To analyze the initial experience in our first patients with ureteropelvic junction obstruction (UPJO) treated by laparoscopic surgery. Patients and methods: All laparoscopic Anderson-Hynes pyeloplasties performed from July 2007 to April 2009 were analyzed. Before surgery, patients underwent a renal ultrasound and isotope renogram. A double J catheter was left in place and subsequently removed. Patients were followed up by ultrasound and renography. Results: Fourteen patients with a median age of 8.6 years were analyzed. Preoperative ultrasound showed a median renal pelvis diameter of 34.5mm. Median operating time was 235min, and median hospital stay 5.5 days. Median renal pelvis diameter decreased in all patients (13.5mm). Conclusions: Laparoscopy is an effective procedure for UPJO correction in children, although operating times are still long (AU)

Lobectomía toracoscópica: Experiencia inicial / Thoracoscopic lobectomy: initial experience

Objetivo. Analizar nuestra experiencia inicial en el tratamiento de malformaciones pulmonares mediante lobectomía toracoscópica. Material y método. Hemos revisado nuestros primeros 6 casos del obectomía toracoscópica realizados en el último año (2008-09). Hemos realizado 6 lobectomías toracoscópicas en 6 pacientes varones con una edad media de 16 meses (6 m-4 años). Por localización se realizaron: 3lobectomías inferiores (2 derechas y una izquierda), 2 lobectomías superiores derechas y una lobectomía superior izquierda con preservación lingular. La patología de base fue la malformación adenomatoidea quística en 5 casos (dos de ellos asociados a secuestro intralobar) y un enfisema lobar por atresia bronquial. Resultados. Se utilizó una intubación selectiva en 4 casos y una intubación traqueal con bloqueador bronquial en dos casos. Ningun caso requirió reconversión a toracotomía. El tiempo operatorio medio fue de (..) (AU)

Aim. Analizing our preliminary experience in the treatment of pulmonary malformations with thoracoscopic lobectomy. Material and methods. We have reviewed our first cases of thoracoscopic lobectomy during last year (2008-09). We have performed6 thoracoscopic lobectomies in 6 male patients with a mean age of 16months (6 months-4 years). They were 3 lower lobectomies (2 right and one left), 2 right upper lobectomies and one lingular sparing left upper lobectomy. Lung lesion was a congenital cystic adenomatoid malformation in 5 (2 of them asociated with intralobar sequestration) and one lobar emphysema due to bronquial atresia. Results. Selective bronchial intubation was used in 4 cases and and tracheal intubation with bronchial blocker in 2. There were no conversions to open thoracotomy. Mean operative time was 202’ (155-250’). There were no intraoperative nor postoperative complications. None of these patients needed blood transfusion. Mean drainage time (..) (AU)

[Thoracoscopic lobectomy: initial experience]. / Lobectomía toracoscópica: experiencia inicial.

AIM: Analizing our preliminary experience in the treatment of pulmonary malformations with thoracoscopic lobectomy. MATERIAL AND METHODS: We have reviewed our first cases of thoracoscopic lobectomy during last year (2008-09). We have performed 6 thoracoscopic lobectomies in 6 male patients with a mean age of 16 months (6 months-4 years). They were 3 lower lobectomies (2 right and one left), 2 right upper lobectomies and one lingular sparing left upper lobectomy. Lung lesion was a congenital cystic adenomatoid malformation in 5 (2 of them asociated with intralobar sequestration) and one lobar emphysema due to bronquial atresia. RESULTS: Selective bronchial intubation was used in 4 cases and and tracheal intubation with bronchial blocker in 2. There were no conversions to open thoracotomy. Mean operative time was 202' (155-250'). There were no intraoperative nor postoperative complications. None of these patients needed blood transfusion. Mean drainage time was 3.5 days (3-4 d) and mean discharge time was 4.8 days (4-7 d). With a mean follow-up time of 5.3 months (2 m-12 m), all of the patients have no symptoms and X-ray are normal. CONCLUSIONS: Thoracoscopic lobectomy is a safe and efective approach to treat congenital pulmonary pathology. The keys to perform it safely are good anesthetic management, adequate instruments for children size, and careful disection of broncovascular structures. Advantages of the minimal access surgery and implementation and miniaturization of the instruments and sealing devices will favor its progressive use.