[Role of pediatric urologist in the treatment of congenital adrenal hyperplasia: a study of satisfaction and psychosocial aspects]. / Papel del urólogo pediátrico en el tratamiento de la hiperplasia suprarrenal congénita: estudio de satisfacción y aspectos psicosociales.

OBJECTIVE: Study the role of the pediatric urologist in the treatment of CAH and the satisfaction of families and patients to identify the psychosocial aspects that we can improve. MATERIAL AND METHODS: Retrospective study in girls with CAH treated in our center. We reviewed the medical records, analyzing the variables: place of birth, age at diagnosis, surgery, complications and follow up. Analysis of satisfaction and psychosocial aspects by telephone survey. RESULTS: Between 1975-2011, 25 girls with CAH have been treated in our center. Cystoscopy and vaginoscopy was performed before clitoroplasty in 68% (16 girls), adding vulvovaginoplasty in 40% and vaginal descent in the 20%. The mean age was 8.78 +/- 2.30 months. Vaginal stenosis was the main complication (36%), performing introitus plasty in two girls, vaginal expansion in other 2 and dilation of the rest. 15 surveys were made, all expressed satisfaction with treatment, and only 6.67% reported shortages information. With the aesthetic results of the genitoplasty 20% showed dissatisfaction. The family concern was constant at 60%, and sporadic in the rest. 13.3% required psychological support. Currently 80% have normal psychosocial life. CONCLUSION: The HSC requires a multidisciplinary approach right from birth to allow adequate psychosocial development. The pediatric urologist has an important weight in the multidisciplinary treatment. Realizing early feminizing genitoplasty decreases family impact and increases satisfaction. The prolonged follow-up will allow the detection and treatment of complications.

[Evaluation of urodynamics and continence in bladder augmentations with sigmoids]. / Evaluación urodinámica y de la continencia en las ampliaciones vesicales con sigmoides.

AIM: To evaluate our experience in sigmoid augmentation to manage renal upper tract dilatation and urinary incontinence. MATERIAL AND METHODS: Retrospective descriptive study of the augmentation cystoplasties with sigmoid patch. We analyze clinical, urodinamic and surgical parameters. RESULTS: We have make 30 cistoplasties with a mean age of 10.24 years (3-15 years) with a mean follow up of 8 years (9 months-15 years). The main diagnosis was neurogenic bladder (63,3%) being the main indication for the augmentation the progressive dilatation of the renal upper tract (43,3%). We associate to the procedure the collocation of an artificial sphinter (30%), Mitrofanoff or ureteral reimplantation. There was no major complication. In the urodinamics, the bladders had low capacity, high pression and low compliance. After surgery, urodinamic parameters improve. During follow up, continence improve with more intermittent clean catheterism (median 4/day). Vesical lithiasis was more common late complication with nor acute abdominal surgical illness nor malignancy; 2 patients finished in renal transplantation. Evolution was positive in 66%, and negative in 18,5%. CONCLUSIONS: Sigmoid augmentation cystoplasty is a good technique, that allows urodinamic and continence improvement. The conscience in the importance of intermittent catheterisms reduces the incidence of complications.

[Results of living donor kidney transplant in pediatric recipients, with graft obtained by laparoscopy]. / Resultados del trasplante renal de donante vivo en receptores pediátricos, con injertos obtenidos por laparoscopia.

OBJECTIVE: Analyze the results of the living related donor kidney transplant (LRDKT) in our center. PATIENTS AND METHODS: Between December 2005 and 2008, 34 kidney transplants in pediatric recipients were performed in our center, 7 (20.58%) of which were LRDKT with grafts obtained via laparoscopy. The donor was the mother in 4 cases and the father in 3. Mean age of the donors was 43 years (38-48) and of the recipients 12.5 years (9-17). Four were a first transplant (one of them planned) and three retransplantations. RESULTS: Cold ischemia time was < 2 hours in every case while warm ischemia did not show significant differences with the cadaveric donor transplant. None had initial graft dysfunction. No vascular complications occurred, but there was a urinary fistula secondary to ureteral necrosis, resolved with a new reimplantation. Survival of the patient and graft is 100%, superior to that of the cadaveric grafts within the same period. Current mean plasma creatinine is 0.8 mg/dl (0.7-1.39) and mean creatinine clearance is 80 cc/min/1.73 m2 (75-90). No donor had surgical complication and all maintain good kidney function. CONCLUSIONS: The short term results of the LRDKT with grafts obtained by laparoscopy in our center are similar to those described by groups with large experience, which makes it possible to continue offering it with guarantee.

[Biofeedback and electrostimulation in the treatment of non monosymptomatic enuresis]. / Biofeedback y electroestimulación como tratamiento de la enuresis no monosintomática.

AIM: To show our experience with biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis. METHODS: We reviewed biofeedback and electrostimulation techniques in the treatment of complicated enuresis carried out in our institution between 1995 and 2000. We report 99 patients (65 girls and 34 boys) with ages ranging from 5 to 14 years old. A complete urodinamy study divided the patients into 5 groups: detrusor-sphincter dysfunction (DSD) (47 patients), detrusor overactivity (DO) (25 patients), urge syndrome (US) (15 patients), sphincter hypertony (SH) (10 patients) and "retentionist" bladder (RB) (2 patients). Success was defined as less than three wet nights in a month. Biofeedback and electrostimulation program was designed in 10 sessions per week (20 minutes each session) with SIGMAX-Biomedical software. Tibial electrostimulation with SANS-UroSurge equipment was indicated when biofeedback and electrostimulation techniques failed (12 sessions per week, 30 minutes each session). RESULTS. The success rate has been 78.9% in DSD group, 80% in DO group, 85% in US group, 75% in SH group, 100% in RB group. CONCLUSIONS: Effectiveness of biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis has been reported and seems to be permanent in time.

[Ureteral meatotomy associated with vesicostomy, a possible urinary derivation?]. / Meatotomía ureteral asociada a vesicostomía, una posibilidad de derivación urinaria?

AIM: To show our experience in urinary derivation by ureteral meatotomy associated with vesicostomy. METHODS: We reviewed uni or bilateral ureteral meatotomy associated with vesicostomy carried out in our institution between 1989 and 2006. We report 20 patients (15 boys and 5 girls) with ages ranging from 1 month to 13-years-old (median 4,4-years-olds). Nine (45%) had neuropathic bladder, 6 (30%) posterior urethral valves and 5 (25%) vesicoureteral stenosis. RESULTS: Improvement of the ureteral dilatation controlled by ultrasound was demonstrated in 100% of the patients. Improvement of the renal function was observed in the group of patients (5) with renal failure. COMPLICATIONS: 2 bladder prolapses, 1 calculus and 1 postoperative bladder bleeding. CONCLUSIONS: Ureteral meatotomy associated with vesicostomy is an effective urinary derivation in children with obstructive urological conditions with an important dilatation in which ureteral reimplantation seems to be difficult. This derivation avoids bladder dysfunction and the management of the vesicostomy is comfortable by the use of a bag or the nappies.

[Complex vesicoureteral reflux. Our experience]. / Reflujo vesicoureteral complejo. Revisión de nuestra serie.

OBJECTIVE: To analize the proportion of complex reflux in the whole amount of patients treated endoscopically of vesicoureteral reflux in our hospital. To determine the endoscopic treatment success in complex reflux, and the influence of reflux grade in it. MATERIAL AND METHODS: We present our experience between 1992 and 2003 with three kinds of substances (polytetrafluoroethylene, polydimethylsiloxane and dextranomer-hyaluronic acid copolymer). We treated complex reflux in 74 patients with endoscopic injection. All patients were scheduled to have voiding cystourethrogram 3 and 9 moths after injection. A positive response was defined as grade 0 or I reflux. RESULTS: Reflux was solved using the endoscopic procedure in 86.25% after first injection, 93.75% after second and 96.25% after third. The corresponding results for reflux grade II, III and IV were 88.9%, 83.3% and 100%. CONCLUSIONS: We conclude that subureteral injection of different sustances (Teflon, Macroplastique or Deflux) is a useful treatment for most cases of vesicoureteral reflux. We propose it as first step of treatment.

[Spigelian hernia: two cases associated to cryptorchidism]. / Hernia de Spiegel: a propósito de 2 casos asociados a criptorquidia.

Spigelian hernia (SH) is rare in children, it occurs primarily en adults the mean age of presentacion is 50 years. We present two patients with hernia associated to cryptorchidism one of them bilateral.

[Usefulness of echography in the diagnosis of intestinal intussusception]. / Utilidad de la ecografía en el diagnóstico de invaginación intestinal.

The usefulness of echography in the diagnosis and tracing down of an intestinal intussusception is discussed. An abdominal ecograph was done in 29 children with suspected intestinal intussusception. In 31 cases (63%) the diagnosis was confirmed by the typical "target" image. In 17 cases (34%) the picture of intussusception was not detected, all children evolved favourably except for one case which, upon revision of the ecograph, showed the "target" picture not properly interpreted in the first place. We find the abdominal ecograph a useful means for diagnosis of intestinal intussusception. We present the diagnostic-therapeutic routine in our centre in cases of possible intestinal intussusception.

[Caustic burns of the esophagus in childhood. Our 14 years' experience]. / Causticación de esófago en la infancia. Nuestra experiencia de catorce años.

A 14-years revision (1972-1986) is made of 3,600 children attended to after ingesting some type of caustic agent. Only 81 were admitted to hospital. We found a predominance in the 1-3 year age group. Bleach was the caustic most frequently present but lye accounted for most major lesions. The more relevant symptoms were oropharyngeal lesions (85%), vomiting (26%) and sialorrhea (20%). Oropharyngeal burns was the sign most often found in esophageal lesions (45%). The ingestion of ordinary household bleach did not result in serious esophageal lesions nor posterior complications, and does not require esophagoscopy if no other symptom except vomiting is present. Esophagoscopy is the ideal means for evaluating esophageal lesions, as are esophageal dilatations with Rehbein dilators for stenosis due to scarring. With the use of corticosteroids in the acute phase, there were 8 cases (22%) of esophageal stenosis out of 36 with lesions.

[Ovarian torsion in early childhood]. / Torsión de ovario en la edad infantil.

Three cases of torsion of normal the uterine adnexa in premenarcheal girls are reported. The possible etiopathogenic mechanisms are commented, and the operative management is discussed. The value of ultrasonography in early diagnosis is pointed out.

Papel del urólogo pediátrico en el tratamiento de la hiperplasia suprarrenal congénita: estudio de satisfacción y aspectos psicosociales / Role of pediatric urologist in the treatment of Congenital adrenal hyperplasia: a Study of satisfaction and psychosocial aspects

OBJETIVO: Estudiar el papel del urólogo en el tratamiento de la hiperplasia suprarrenal congénita (HSC) y la satisfacción de familiares y pacientes, para identificar los aspectos psicosociales que podemos mejorar.Material y métodos. Estudio retrospectivo de niñas con HSC tra-tadas en nuestro centro. Revisamos las historias clínicas, analizando las variables: lugar de nacimiento, edad de diagnóstico, cirugía, complica-ciones y seguimiento posterior. Análisis de la satisfacción y psicosocial mediante encuesta telefónica.Resultados. Entre 1975-2011, 25 niñas con HSC han sido tratadas en nuestro centro. Se realizó cistoscopia/vaginoscopia previa clitoro-plastia en el 68% (16 niñas), añadiendo vulvovaginoplastia al 40% y descenso vaginal al 20%. La edad media fue de 8,78±2,30 meses. La estenosis vaginal fue la principal complicación (36%), realizándose introitoplastia en dos niñas, ampliación vaginal en otras 2 y dilataciones en el resto. Se hicieron 15 encuestas, todos manifestaron satisfacción con el tratamiento, sólo el 6,67% refirió escasez de información. Con los resultados estéticos de la genitoplastia un 20% mostraron insatisfacción. La preocupación familiar fue constante en el 60%, siendo esporádica en el resto. El 13,3% requirió apoyo psicológico. Actualmente el 80% llevan una vida psicosocial normal. CONCLUSIÓN: La HSC requiere de un correcto tratamiento multi-disciplinar desde el nacimiento para permitir un adecuado desarrollo psicosocial. El urólogo pediátrico tiene un importante peso en el trata-miento multidisciplinar. Realizando la genitoplastia feminizante precoz disminuye el impacto familiar y aumenta la satisfacción. El seguimiento prolongado permitirá la detección y tratamiento de las complicaciones

OBJECTIVE: Study the role of the pediatric urologist in the treatment of CAH and the satisfaction of families and patients to identify the psychosocial aspects that we can improve. MATERIAL AND METHODS: Retrospective study in girls with CAH treated in our center. We reviewed the medical records, analyzing the variables: place of birth, age at diagnosis, surgery, complications and follow up. Analysis of satisfaction and psychosocial aspects by tel-ephone survey. RESULTS: Between 1975-2011, 25 girls with CAH have been treated in our center. Cystoscopy and vaginoscopy was performed before clito-roplasty in 68% (16 girls), adding vulvovaginoplasty in 40% and vaginal descent in the 20%. The mean age was 8.78 ± 2.30 months. Vaginal stenosis was the main complication (36%), performing introitus plasty in two girls, vaginal expansion in other 2 and dilation of the rest. 15 surveys were made, all expressed satisfaction with treatment, and only 6.67% reported shortages information. With the aesthetic results of the genitoplasty 20% showed dissatisfaction. The family concern was con-stant at 60%, and sporadic in the rest. 13.3% required psychological support. Currently 80% have normal psychosocial life. CONCLUSION: The HSC requires a multidisciplinary approach right from birth to allow adequate psychosocial development. The pediatric urologist has an important weight in the multidisciplinary treatment. Realizing early feminizing genitoplasty decreases family impact and increases satisfaction. The prolonged follow-up will allow the detection and treatment of complications

Evaluación urodinámica y de la continencia en las ampliaciones vesicales con sigmoides / Evaluation of urodynamics and continence in bladder augmentations with sigmoids

Objetivo. Queremos evaluar nuestra experiencia en las cistoplastias con sigmoides en el manejo de la dilatación del tracto urinario superior y la incontinencia urinaria. Material y métodos. Realizamos un estudio descriptivo retrospectivo de las ampliaciones realizadas con sigmoides (1994-2009). Analizamos parámetros clínicos, quirúrgicos y especialmente urodinámicos, pre/postcistoplastia. Resultados. Hemos realizado 30 cistoplastias con una edad de 10,24años (3-15 años), siguiéndose 8 años (9 meses-15 años). El diagnóstico de base era la vejiga neurógena (63,3%), siendo la indicación principal para la ampliación la afectación del tracto urinario superior 43,3%)y la incontinencia. El procedimiento se asoció a la colocación de esfínter artificial (30%), estoma tipo Mitrofan off (30%) o reimplante ureteral(30%), No existiendo ninguna complicación (..) (AU)

Aim. To evaluate our experience in sigmoid augmentation to manage renal upper tract dilatation and urinary incontinence. Material and methods. Retrospective descriptive study of the augmentation cystoplasties with sigmoid patch. We analyze clinical, urodynamic and surgical parameters. Results. We have make 30 cistoplasties with a mean age of 10.24years (3-15 years) with a mean follow up of 8 years (9 months-15 years).The main diagnosis was neurogenic bladder (63,3%) being the main indication for the augmentation the progressive dilatation of the renal upper tract (43,3%). We associate to the procedure the collocation of an artificial sphinter (30%), Mitrofan off or ureteral reimplantation. There was no major complication. In the urodinamics, the bladders had low (..) (AU)

Reflujo vesicoureteral complejo. Revisión de nuestra serie / Complex vesicoureteral reflux. Our experience

Objetivos: Analizar la proporción de reflujos secundarios o complejos en el total de reflujos vesicoureteral estratados endoscópicamente en nuestro hospital. Determinar el éxito conseguido y su relación con el grado de reflujo presentado. Material y método: Presentamos nuestra experiencia entre 1992 y 2003 con tres tipos de sustancias(politetrafluoroetileno, polidimetilsiloxane y dextranomero-copolímero de ácido hialurónico). Tratamos endoscópicamente con la inyección de estas sustancias a 74 pacientes con reflujo vesicoureteral complejo. Todos ellos se siguieron sistemáticamente mediante cistografía a los 3 y 9 meses tras la inyección. Definimos éxito del tratamiento como aquellos reflujos grado 0 ó I. Resultados: El reflujo fue solucionado endoscópicamente en el 86,25% de las ocasiones en el primer intento, 93,75% tras el segundo y 96,25% tras el tercero. El éxito según el grado de reflujo fue 88,9% para los de grado II, 83,3% para los de grado III y 100% para los de IV. Conclusiones: Concluimos que la inyección subureteral de distintas sustancias (Teflon®,Macroplastique® o Deflux®) constituye una alternativa útil de tratamiento en la mayoría de reflujos vesicoureterales complejos. Opinamos que debe considerarse como el primer escalón del tratamiento (AU)

Objective: To analize the proportion of complex reflux in the whole amount of patients treated endoscopically of vesicoureteral reflux in our hospital. To determine the endoscopic treatment success in complex reflux, and the influence of reflux grade in it. Material and methods: We present our experience between 1992 and 2003 with three kinds of substances (polytetrafluoroethylene, polydimethylsiloxane and dextranomer-hyaluronic acid copolymer). We treated complex reflux in 74 patients with endoscopic injection. All patients were scheduled to have voiding cystourethrogram 3 and 9 moths after injection. A positive response was defined as grade 0 or I reflux. Results: Reflux was solved using the endoscopic procedure in 86,25% after first injection, 93,75% after second and 96,25% after third. The corresponding results for reflux grade II, III and IV were 88.9%, 83.3% and 100%. Conclusions: We conclude that subureteral injection of different sustances (Teflon®, Macroplastique® or Deflux®) is a useful treatment for most cases of vesicoureteral reflux. We propose it as first step of treatment (AU)

Resultados del trasplante renal de donante vivo en receptores pediátricos, con injertos obtenidos por laparoscopia / Results of living donor kidney transplant in pediatric recipients, with graft obtained by laparoscopy

Objetivo. Analizar los resultados del trasplante renal de donante vivo relacionado (TDVR) en nuestro centro. Pacientes y método. Entre diciembre de 2005 y 2008 se han realizado en nuestro centro 34 trasplantes renales en receptores pediátricos, de los que 7 (20,58%) han sido TDVR con injertos obtenidos por vía laparoscópica. El donante fue la madre en 4 casos y el padres entres. La edad media de los donantes fue de 43 años (38-48) y la de los receptores de 12,5 años (9-17). Cuatro fueron un primer trasplante (uno (..) (AU)

Objective. Analyze the results of the living related donor kidney transplant (LRDKT) in our center. Patients and methods. Between December 2005 and 2008, 34 kidney transplants in pediatric recipients were performed in our center, 7(20.58%) of which were LRDKT with grafts obtained via laparoscopy. The donor was the mother in 4 cases and the father in 3. Mean age of the donors was 43 years (38-48) and of the recipients 12.5 years (9-17).Four were a first transplant (one of them planned) and three (..) (AU)

Biofeedback y electroestimulación como tratamiento de la enuresis no monosintomática / Biofeedback and electrostimulation in the treatment of non monosymptomatic enuresis

Objetivo. Mostrar nuestra experiencia con las técnicas de biofeedbacky electro estimulación en el tratamiento de la enuresis no monosintomática. Material y métodos. Se analizaron los datos de 99 niños atendidos entre 1995 y 2000 por enuresis no monosintomática con edades comprendidas entre 5 y 14 años (65 niñas y 34 niños). Se les realizó estudio urodinámico completo para definir a los pacientes en cinco grupos: disfunción vesicoesfinteriana (47 pacientes), hiperactividad de detrusor (25 pacientes), urgencia sensorial (15 pacientes), hipertonía de esfínter (10 pacientes) y vejiga “retencionista” (2 pacientes). Se consideró como éxito menos de 3 noches húmedas al mes. El biofeedbacky la electroestimulación consistieron en 10 sesiones semanales de20 minutos con el equipo SIGMAX-Biomedical. Se indicó estimulación tibial en patologías en las que fracasaron tratamientos anteriores(12 sesiones de 30 minutos con el equipo SANS de UroSurge).Resultados. El éxito al fin del tratamiento fue del 78,9% en la disfunción vesicoesfinteriana, del 80% en la hiperactividad del detrusor, del 85% en la urgencia sensorial, del 75% en la hipertonía de esfínter y del 100% en la vejiga “retencionista”.Conclusiones. Los llamados “tratamientos alternativos” como el biofeedback y la electro estimulación son eficaces en el tratamiento dela enuresis no monosintomática. Esta eficacia se mantiene en el tiempo y es independiente de la disfunción miccional hallada (AU)

Aim. To show our experience with biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis. Methods. We reviewed biofeedback and electrostimulation techniques in the treatment of complicated enuresis carried out in our institution between 1995 and 2000. We report 99 patients (65 girls and 34boys) with ages ranging from 5 to 14 years old. A complete urodinamy study divided the patients into 5 groups: detrusor-sphincter dysfunction(DSD) (47patients), detrusor over activity (DO) (25 patients), urge syndrome(US) (15 patients), sphincter hypertony (SH) (10 patients) and “retentionist” bladder (RB) (2 patients). Success was defined as less than three wet nights in a month. Biofeedback and electrostimulation program was designed in 10 sessions per week (20minutes each session)with SIGMAX-Biomedical software. Tibial electrostimulation with SANS-UroSurge equipment was indicated when biofeedback and electrostimulation techniques failed (12 sessions per week,30 minute seach session).Results. The success rate has been 78,9% in DSD group, 80% in DO group , 85% in US group, 75% in SH group, 100% in RB group. Conclusions. Effectiveness of biofeedback and electrostimulation echniques in the treatment of non monosymptomatic enuresis has been reported and seems to be permanent in time (AU)

Meatotomía ureteral asociada a vesicostomía, ¿una posibilidad de derivación urinaria? / Ureteral meatotomy associated with vesicostomy, a possible urinary derivation?

Objetivo. Mostrar nuestra experiencia en la derivación urinaria mediante meatotomía ureteral uni o bilateral asociada a vesicostomía. Material y métodos. Hemos realizado un estudio retrospectivo sobre una serie de 20 pacientes (15 niños y 5 niñas), sometidos a meatotomíaureteral junto con vesicostomía cutánea en nuestro servicio, entre los años 1989 y 2006. La edad media fue de 4,4 años (1 mes-13años). Nueve pacientes (45%) presentaban vejiga neuropática (7 con reflujo vesicoureteral secundario), 6 niños (30%) válvulas de uretra posterior, 3 estenosis vésico-ureterales bilaterales y 2 unilaterales(25%).Resultados. En el 100% de los niños se observó disminución ecográfica de la dilatación ureteropielocalicial tras la derivación; 5 de los casos que presentaban alteración de la función renal, mejoraron tras la intervención, controlado mediante el aclaramiento de creatinina. Como complicaciones se produjo prolapso vesical por la ostomía en 2 pacientes, litiasis en 1 y sangrado vesical postoperatorio en 1.Conclusiones. La meatotomía ureteral asociada a vesicostomía cutánea es una opción válida en niños que presentan una uropatía obstructiva vesical o infravesical con importante dilatación del tracto urinario superior en los que la reimplantación ureteral no se considera que pueda tener éxito. Evita la desfuncionalización vesical y el manejo dela vesicostomía resulta cómodo con bolsa o pañal (AU)

Aim. To show our experience in urinary derivation by ureteralmeatotomy associated with vesicostomy. Methods. We reviewed unior bilateral ureteral meatotomy associated with vesicostomy carried outin our institution between 1989 and 2006. We report 20 patients (15boys and 5 girls) with ages ranging from 1 month to 13 years old (median4,4 years ols). Nueve (45%) had neuropathic bladder, 6 (30%) posterior urethral valves and 5 (25%) vesicoureteral stenosis. Results. Improvement of the ureteral dilatation controlled by ultrasound was demonstrated in 100% of the patients. Improvement of the renal function was observed in the group of patients (5) with renal failure. Complications: 2 bladder prolapses, 1 calculus and 1 postoperative bladder bleeding. Conclusions. Ureteral meatotomy associated with vesicostomy is an effective urinary derivation in children with obstructive urologicalconditions with an important dilatation in which ureteral reimplantation seems to be difficult. This derivation avoids bladder dysfunction and the management of the vesicostomy is comfortable by the use of a (..) (AU)