[Surgical treatment of hypospadias. Our experience and follow up in 1993-1998]. / Tratamiento quirúrgico del hipospadias. Nuestra experiencia y seguimiento durante el período 1993-1998.

OBJECTIVE: To review our series of hypospadias. The incidence of the different types of hypospadias and the complication rates according to the different surgical techniques and materials utilized are analyzed. METHODS: We reviewed our series of 130 patients with hypospadias who underwent surgical correction at the Department of Pediatric Urology from 1993-1998. RESULTS: The patients presented the following types of hypospadias: glandular (13 cases), balano-preputial (56), distal penile (42), mid-penile (9), proximal penile (2) and penoscrotal hypospadias (8). The surgical techniques utilized were the Mickulitz meatotomy procedure (6 cases), MAGPI (24), Mathieu (77), Crawford (5), onlay (7), Duckett (3), Retik (4), Duplay (1), Denis-Brown (2) and penoscrotal transposition (1). The complications commonly observed were fistula (20 cases), hematoma (4), stricture of urethral meatus (4), infection (3), megaurethra (3), skin necrosis (1). CONCLUSIONS: Surgical repair of this developmental anomaly is performed when the patient is approximately 18 months old. In our series 15% of the patients developed fistula, which is similar to the complication rate reported in the literature. However, since we started using monofilament resorbable material, the incidence of fistula has dropped from 20% to approximately 5%. Although other factors are involved, the lower incidence of fistula formation may be largely due to a reduced tissue reaction to foreign body.

[Hypertension secondary to intrarenal aneurysms in childhood]. / Hipertensión secundaria a aneurismas intrarrenales en la infancia.

OBJECTIVES: Arterial hypertension due to renovascular dysfunction is uncommon in children. The most common cause is stenosis of the renal artery and, rarely, aneurysm of secondary arteries. The present case underscores the therapeutic difficulties. Treatment must be based on the clinical symptoms, location, size, number and etiology of these vascular malformations. METHOD/RESULTS: We describe a 4-year-old patient with secondary arterial hypertension arising from several aneurysms in the primary and secondary arterial branches of the right kidney that had been diagnosed by arteriography. After medical treatment had failed, the patient underwent a right nephrectomy since local or conservative procedures could not be done. CONCLUSIONS: It is widely advocated in the literature that patients with medically refractory arterial hypertension warrant surgical treatment. The type of surgery will depend on the location and the characteristics of the lesion.

[Intravesical foreign body caused arising from ureterostomy protective resin-gum]. / Cuerpo extraño intravesical producido por resina-goma protectora de ureterostomía.

OBJECTIVES: Bladder foreign bodies can arise from many factors and are iatrogenic in a high percentage. A case of intravesical foreign body from accumulated fragments of synthetic gum utilized to protect the ureterostomy is described. These problems can be avoided by correct management of the osteotomy and must therefore be emphasized to those responsible for the patient's care. METHODS/RESULTS: A case of a 7-year-old patient with chronic nephropathy and a bilateral high-loop ureterostomy is described. The migration and subsequent condensation of small fragments of the material protecting the ureterostomy led to the formation of a foreign body which took the shape of the bladder. Treatment was by vesicostomy. CONCLUSION: The possible complications arising from the passage of objects from outside into the urinary tract should always be taken into account in patients with an external urinary diversion.

Nefropatías atípicas como causa de nefrectomías en la edad pediátrica / Atypical nephropaties leading to nephrectomy in children

El porcentaje de unidades renales que deben ser extirpadas en la edad pediátrica ha disminuido, gracias al desarrollo de técnicas de diagnóstico precoz y a la aparición de tratamientos quirúrgicos alternativos como la cirugía de banco, las embolizaciones selectivas y el gran avance de la edoscopía renal.Sin embargo un cierto número de patologías nefrourológicas no tienen otra alternativa que la nefrectomía para eliminar el riesgo vital que suponen para el enfermo.Se presentan tres nefropatías, atípicas en la edad pediátrica,cuya evolución obligó a la extirpación del riñón patológico.Se trataba de una pielonefritis xantogranulomatosa que afectaba todo el riñón derecho una hematuria esencial de evolución maligna cuyo diagnóstico etiológico no pudo ser establecido,incluso en el estudio histopatológico y una hipertención secundaria a múltiples anuerismas intrarenales localizados exclusivamente en el riñón derecho

Nefropatías atípicas como causa de nefrectomías en la edad pediátrica / Atypical nephropaties leading to nephrectomy in children

El porcentaje de unidades renales que deben ser extirpadas en la edad pediátrica ha disminuido, gracias al desarrollo de técnicas de diagnóstico precoz y a la aparición de tratamientos quirúrgicos alternativos como la cirugía de banco, las embolizaciones selectivas y el gran avance de la edoscopía renal.Sin embargo un cierto número de patologías nefrourológicas no tienen otra alternativa que la nefrectomía para eliminar el riesgo vital que suponen para el enfermo.Se presentan tres nefropatías, atípicas en la edad pediátrica,cuya evolución obligó a la extirpación del riñón patológico.Se trataba de una pielonefritis xantogranulomatosa que afectaba todo el riñón derecho una hematuria esencial de evolución maligna cuyo diagnóstico etiológico no pudo ser establecido,incluso en el estudio histopatológico y una hipertención secundaria a múltiples anuerismas intrarenales localizados exclusivamente en el riñón derecho

[Latex allergy in children with spina bifida]. / Alergia al látex en niños con espina bífida.

Latex allergy is a frequent happening in children with spina bifida or congenital urologic abnormalities. These patients have multiples exposures to derivatives of latex as part of the management increasing the risk of allergic reactions. We present three children who developed general anaphylactic reaction during urodynamic exploration with a rectal latex catheter. All patients showed positive skin test and positive latex specific IgE test (RAST). A prospective survey of 17 patients with spina bifida at the time of cystometry showed positive RAST levels in 7 (41%). Recommendations for prophylaxis are included, suggesting the avoidance of latex products in children with spina bifida since birth.

[Upper obstructive uropathies in newborns and infants. Our experience over the past 11 years]. / Uropatías obstructivas altas en el recién nacido y lactante. Nuestra experiencia en los últimos once años.

We review 68 cases of ureterohydronephrosis in the newborn and nursling due to high urinary tract abnormalities, like ureteropelvic junction obstruction, obstructed megaureter, vesicoureteral reflux, renal duplication and simple ureterocele. A diagnostic evaluation is done, referred to his higher precocity, due to prenatal echographic screening. We evaluate also the surgical techniques employed, his complications and his indications. In the last five years, we have found that the definitive surgical correction in the neonatal period ive us good results.

[Urologic obstructions due to fungal balls]. / Obstrucciones urológicas por tapones fúngicos.

Fungal urologic infections are unusual in children. They are associated with chronic uropathies, citostatics and antibiotic treatments and depressed immunity which allow the pathologic growth of a saprofitie organism. This infection must present special forms when the mycotic development is realized in cavities and special advantageous conditions. Then it adopt the form of fungal bezoars, and it can mobilize itself and provoke obstructions in the urinary tract. We present two cases of urinary obstructions secondary to fugal bezoars. The obstruction was localized in the uretero-vesical junction. In both of them the infection was associated with long antibiotic treatment, and with severe immunodeficiency only in one. The diagnosis was possible by echography and direct determination of candida albicans in urine. We proved also temporary ureterovesical stenosis we found before a reflux. The treatment included intravenous and local anfotericine B with dissolution of the bezoar in three and four days respectively.

[Neonatal hypothyroidism secondary to the use of povidone-iodine]. / Hipotiroidismo neonatal secundario a la utilización de povidona yodada

The skin absorption of iodine products in neonates with inhibition of thyroid function has been documented in the past. The use of Povidone-Iodine is the most frequent cause of this type of intoxication. Three neonates in which Povidone-Iodine was used during and after surgery had hypothyroidism secondary to glandular inhibition. They were discovered during the routine Programme for Neonatal Metabolic Diseases and were treated as deficits persists on retesting at 14 days of age. Treatment was maintained during one year, and the follow up controls of TSH-T4 were normal. During the neonatal period the use of Iodine containing antiseptics should be avoided because the potential risk of intoxication and glandular inhibition.