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.

Minimally invasive surgery for neuroblastic tumours: A SIOPEN multicentre study: Proposal for guidelines.

INTRODUCTION: Surgery plays a key role in the management of Neuroblastic tumours (NB), where the standard approach is open surgery, while minimally invasive surgery (MIS) may be considered an option in selected cases. The indication(s) and morbidity of MIS remain undetermined due to small number of reported studies. The aim of this study was to critically address the contemporary indications, morbidity and overall survival (OS) and propose guidelines exploring the utility of MIS for NB. MATERIALS & METHODS: A SIOPEN study where data of patients with NB who underwent MIS between 2005 and 2018, including demographics, tumour features, imaging, complications, follow up and survival, were extracted and then analysed. RESULTS: A total of 222 patients from 16 centres were identified. The majority were adrenal gland origin (54%) compared to abdominal non-adrenal and pelvic (16%) and thoracic (30%). Complete and near complete macroscopic resection (>95%) was achieved in 95%, with 10% of cases having conversion to open surgery. Complications were reported in 10% within 30 days of surgery. The presence of IDRF (30%) and/or tumour volume >75 ml were risk factors for conversion and complications in multivariate analysis. Overall mortality was 8.5%. CONCLUSIONS: MIS for NB showed that it is a secure approach allowing more than 95% resection. The presence of IDRFs was not an absolute contraindication for MIS. Conversion to open surgery and overall complication rates were low, however they become significant if tumour volume >75 mL. Based on these data, we propose new MIS guidelines for neuroblastic tumours.

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.

Surgical treatment of pulmonary aspergilloma in pediatric patients: report of 3 cases. / Tratamiento quirúrgico del aspergiloma pulmonar en pacientes pediátricos. A propósito de tres casos.

OBJECTIVE: To describe our experience in the surgical management of pulmonary aspergilloma (PA) and review surgery's role in PA treatment in pediatric patients. MATERIAL AND METHODS: A descriptive study of patients diagnosed with PA undergoing surgical resection from 2017 to 2019 was carried out. A review of pediatric studies mentioning "aspergilloma", "surgical", and "treatment" was performed. RESULTS: During the study period, 3 patients with single PA aged 18 months old, 3 years old, and 13 years old underwent surgery. All of them had leukemia and little or no response to aspergilloma medical treatment. In all patients, the procedure was initiated using the thoracoscopic route, but conversion into thoracotomy was required in two cases. In all three cases, pulmonary segmentectomy was carried out with complete PA removal, without severe intraoperative or postoperative complications. No pulmonary recurrence was observed after 30-, 34-, and 16-month follow-up, respectively. CONCLUSIONS: PA surgical resection is a feasible alternative in pediatric patients with a poor antifungal treatment response or related complications.

OBJETIVOS: El objetivo de este trabajo es describir la experiencia de nuestro centro en el manejo quirúrgico del aspergiloma pulmonar (AP) y la realización de una revisión sobre el papel de la cirugía en el tratamiento del AP en el niño. MATERIAL Y METODOS: Estudio descriptivo de los pacientes diagnosticados e intervenidos mediante resección del AP desde el 2017 hasta el 2019. Se realizó una revisión con los términos "aspergilloma", "surgical", "treatment", descartando los estudios no referidos a pacientes pediátricos. RESULTADOS: Durante el periodo de estudio se intervinieron 3 pacientes con AP único, de 18 meses, 3 y 13 años de edad respectivamente, los 3 afectos de leucemia y con poca o nula respuesta al tratamiento médico habitual del aspergiloma. En todos los pacientes se inició la intervención por vía toracoscópica, siendo necesaria la conversión a toracotomía en 2 casos. En los tres casos se realizó segmentectomía pulmonar con exéresis completa del AP, sin complicaciones intraoperatorias ni postoperatorias graves. No se observaron recidivas pulmonares tras un seguimiento de 30, 34 y 16 meses respectivamente. CONCLUSIONES: La resección quirúrgica del AP, se presenta como una alternativa factible en pacientes pediátricos con pobre respuesta a tratamiento antifúngico o con complicaciones derivadas de este.

Tratamiento quirúrgico del aspergiloma pulmonar en pacientes pediátricos. A propósito de tres casos / Surgical treatment of pulmonary aspergilloma in pediatric patients: report of 3 cases

OBJETIVOS: El objetivo de este trabajo es describir la experiencia de nuestro centro en el manejo quirúrgico del aspergiloma pulmonar (AP) y la realización de una revisión sobre el papel de la cirugía en el tratamiento del AP en el niño. MATERIAL Y MÉTODOS: Estudio descriptivo de los pacientes diagnosticados e intervenidos mediante resección del AP desde 2017 hasta 2019. Se realizó una revisión con los términos "aspergiloma", "surgical", "treatment", descartando los estudios no referidos a pacientes pediátricos. RESULTADOS: Durante el periodo de estudio se intervinieron tres pacientes con AP único, de 18 meses, 3 y 13 años de edad respectivamente, los 3 afectos de leucemia y con poca o nula respuesta al tratamiento médico habitual del aspergiloma. En todos los pacientes se inició la intervención por vía toracoscópica, siendo necesaria la conversión a toracotomía en dos casos. En los tres casos se realizó segmentectomía pulmonar con exéresis completa del AP, sin complicaciones intraoperatorias ni posoperatorias graves. No se observaron recidivas pulmonares tras un seguimiento de 30, 34 y 16 meses respectivamente. CONCLUSIONES: La resección quirúrgica del AP se presenta como una alternativa factible en pacientes pediátricos con pobre respuesta a tratamiento antifúngico o con complicaciones derivadas de este

OBJECTIVE: To describe our experience in the surgical management of pulmonary aspergilloma (PA) and review surgery's role in PA treatment in pediatric patients. MATERIALS AND METHODS: A descriptive study of patients diagnosed with PA undergoing surgical resection from 2017 to 2019 was carried out. A review of pediatric studies mentioning "aspergilloma", "surgical", and "treatment" was performed. RESULTS: During the study period, 3 patients with single PA aged 18 months old, 3 years old, and 13 years old underwent surgery. All of them had leukemia and little or no response to aspergilloma medical treatment. In all patients, the procedure was initiated using the thoracoscopic route, but conversion into thoracotomy was required in two cases. In all three cases, pulmonary segmentectomy was carried out with complete PA removal, without severe intraoperative or postoperative complications. No pulmonary recurrence was observed after 30-, 34-, and 16-month follow-up, respectively. CONCLUSIONS: PA surgical resection is a feasible alternative in pediatric patients with a poor antifungal treatment response or related complications

Case presentation: Concomitant avulsion fracture of the posterior calcaneal tubercle and rupture of the Achilles tendon. / Presentación de caso: fractura avulsión del tubérculo posterior de calcáneo con rotura de tendón de Aquiles en un tiempo.

The Achilles tendon acts by transmitting the force created by the contraction of the sural triceps to the calcaneus. This allows the elevation during the gait cycle. A sudden contraction in elderly patients may generate avulsion fracture of the posterior tubercle of the calcaneus due to poor bone quality or rupture of the tendon, with one of these two structures yielding in most cases. We report the case of a 72-year-old woman who suffered a low energy right heel trauma while stepping off the bus. She was diagnosed an avulsion fracture of the posterior tubercle of the calcaneus. When performing ORIF procedure of the fracture, an associated rupture of the Achilles tendon is diagnosed. Both pathologies are treated in the same surgical act. We recommend using a second imaging study along with the x-ray in order to anticipate associated injuries and adequate surgical planning in elderly patients.

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.

Renal Artery Dissection in a Young Woman: Diagnoses Beyond Fibromuscular Dysplasia.

A 31-year-old woman presented at the emergency room after experiencing colic pain in the right iliac fossa for 5 days. She had previously consulted another center, where deterioration of renal function had been identified and abdominal computed tomography (CT) angiography had shown a dissection of the right renal artery, with areas suggestive of infarction in the right kidney, as well as an aneurysm in the left renal artery and a smaller left kidney. The patient had no relevant family or personal history except posttraumatic carotid-cavernous fistula in 2014, which had been treated with embolization. In our hospital, the patient was hypertensive and acute renal failure was confirmed, accompanied by an increase in lactate dehydrogenase and isomorphic microhematuria. After a new CT Scan, in addition to the lesions described in the renal arteries, another aneurysm in the splenic artery and an aneurysm of the right femoral artery were identified. Antihypertensive treatment was initiated with calcium antagonists and anticoagulation. Subsequent renal arteriography confirmed the dissection of the right renal artery, which could not be repaired, and a coated stent was placed in the left renal artery to exclude the aneurysm. The splenic artery lesion was treated 2 months later. The etiological diagnosis in this young woman was challenging. The presence of visceral aneurysms suggested a differential diagnosis comprising fibromuscular dysplasia, vasculitis, and collagenopathies. Using a multidisciplinary approach and directed anamnesis, the presence of frequent sprains, joint hypermobility, and skin fragility was confirmed. Blood immunology and CT angiography including the thoracic and cervical territories were normal. Echocardiography revealed tricuspid insufficiency. All these data suggested the presence of a collagen-like Ehlers-Danlos syndrome (vascular form). The diagnosis was confirmed by the genetic study, which showed a pathogenic mutation in the COL3A1 gene. Currently, the patient is asymptomatic with recovered renal function following treatment with a beta-blocker and antiplatelet therapy.

Desarrollo y optimización de un modelo animal para el estudio de las células ganglionares en enfermedad degenerativa de la retina y nervio óptico / Development and optimisation of an animal model for the study of ganglion cells in degenerative diseases of the retina and optic nerve

Introducción: La esclerosis múltiple es una enfermedad autoinmune, crónica e inflamatoria del sistema nervioso central con desmielinización axonal, gliosis y neurodegeneración. Considerada una causa frecuente de discapacidad neurológica en adultos jóvenes. En este trabajo, se ha optimizado un modelo de encefalomielitis autoinmune experimental (EAE), mediante la inyección de glicoproteína mielínica de los oligodendrocitos (MOG35-55), se han estudiado las repercusiones oftalmológicas, y se plantea su uso como modelo de experimentación en otros estudios de degeneración de las células ganglionares (CGR) y del nervio óptico (NO). Material y métodos: Dieciséis ratones de 10 semanas en 2 grupos de estudio: grupo control 10 animales y grupo con EAE 6 animales. Al grupo EAE se le inyectó MOG35-55. Los animales del modelo EAE, fueron monitorizados mediante escalas de discapacidad motora. Las retinas y los nervios ópticos se procesaron para examen morfológico a microscopia óptica y estudio ultraestructural. Resultados: Los modelos animales presentaron clínica motora de lesión medular, apareciendo los primeros síntomas entre el 7.°-19.° día postinyección. Con un promedio de discapacidad máxima de 3,5puntos. En retina, el promedio de CGR en el grupo EAE fue de 0,0891μm frente a 0,1678μm del grupo control (p = 0,0003). El NO se vio intensamente afectado con una gliosis reactiva, aumento del daño axonal y disminución de la densidad axonal (grupo control 0,38038 axones/μm2 frente al grupo EAE 0,16 axones/μm2; p = 0,00032). Conclusiones: En este trabajo hemos caracterizado y detallado un modelo animal de EAE para el estudio de alteraciones desmielinizantes en retina y NO. Sus características lo convierten en un magnífico instrumento para el estudio de las enfermedades oftalmológicas neurodegenerativas

Introduction: Multiple sclerosis is an autoimmune, chronic and inflammatory disease of the central nervous system with axonal demyelination, gliosis and neurodegeneration. It is considered a frequent cause of neurological disability in young adults. In this work, an Experimental Autoimmune Encephalomyelitis (EAE) model was optimised by injecting a myelin oligodendrocyte glycoprotein (MOG35-55). The ophthalmological effects were studied, as well as its use as an experimental model in other studies of retinal ganglion cell degeneration (RGC) and optic nerve (ON). Material and methods: The study included 16 mice of 10 weeks that were placed into 2 study groups: a control group of 10 animals and another group of 6 animals with EAE that were injected with MOG35-55. The animals of the EAE model were monitored using motor disability scales. The retinas and optic nerves were processed for morphological examination by optical microscopy and ultrastructure studies. Results: The animal models presented with motor symptoms of spinal cord injury, with the first symptoms appearing between the 7 th and 19 th day post-injection, with a maximum disability mean of 3.5 points. In the retina, the mean RGC in the EAE group was 0.0891 μm, compared with 0.1678 μm of the control group (p = .0003). The ON was strongly affected with reactive gliosis, increased axonal damage and decreased density axonal (control group 0.38038 axons/μm2 versus EAE group 0.16 axons/μm2, p = .00032). Conclusions: In this work an animal model of EAE has been characterised and detailed for the study of demyelinating alterations in the retina and the ON. Its characteristics make it an excellent tool for the study of neurodegenerative ophthalmic diseases

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.

Development and optimisation of an animal model for the study of ganglion cells in degenerative diseases of the retina and optic nerve. / Desarrollo y optimización de un modelo animal para el estudio de las células ganglionares en enfermedad degenerativa de la retina y nervio óptico.

INTRODUCTION: Multiple sclerosis is an autoimmune, chronic and inflammatory disease of the central nervous system with axonal demyelination, gliosis and neurodegeneration. It is considered a frequent cause of neurological disability in young adults. In this work, an Experimental Autoimmune Encephalomyelitis (EAE) model was optimised by injecting a myelin oligodendrocyte glycoprotein (MOG35-55). The ophthalmological effects were studied, as well as its use as an experimental model in other studies of retinal ganglion cell degeneration (RGC) and optic nerve (ON). MATERIAL AND METHODS: The study included 16 mice of 10 weeks that were placed into 2 study groups: a control group of 10 animals and another group of 6 animals with EAE that were injected with MOG35-55. The animals of the EAE model were monitored using motor disability scales. The retinas and optic nerves were processed for morphological examination by optical microscopy and ultrastructure studies. RESULTS: The animal models presented with motor symptoms of spinal cord injury, with the first symptoms appearing between the 7th and 19th day post-injection, with a maximum disability mean of 3.5 points. In the retina, the mean RGC in the EAE group was 0.0891µm, compared with 0.1678µm of the control group (p=.0003). The ON was strongly affected with reactive gliosis, increased axonal damage and decreased density axonal (control group 0.38038 axons/µm2 versus EAE group 0.16 axons/µm2, p=.00032). CONCLUSIONS: In this work an animal model of EAE has been characterised and detailed for the study of demyelinating alterations in the retina and the ON. Its characteristics make it an excellent tool for the study of neurodegenerative ophthalmic diseases.