Usefulness of indocyanine green in the laparoscopic Palomo technique: a comparative study. / Utilidad del verde de indocianina en el procedimiento de Palomo laparoscópico: estudio comparativo.

OBJECTIVE: To find out whether the use of indocyanine green for lymphatic sparing in the laparoscopic Palomo technique reduces the incidence of postoperative hydrocele. MATERIALS AND METHODS: A comparative cohort study of varicocele patients treated with the laparoscopic Palomo technique from 2008 to 2023 was carried out. Patients were divided into two groups according to whether fluorescence lymphography (intratesticular indocyanine green) had been performed or not. Epidemiological, surgical, and clinical data, as well as complications, were recorded. A hypothesis test was conducted using the SPSS software. RESULTS: 30 patients undergoing varicocele surgery through the laparoscopic Palomo technique were included. They were divided into two groups -lymphatic sparing (n= 13) vs. spermatic vessel ligation without sparing (n= 17). Mean age at surgery was 14 years. 5 cases of postoperative hydrocele were identified in the no lymphatic sparing group. 1 of them required surgery for hydrocele treatment. No hydrocele cases were noted in the lymphography group. The difference was statistically significant (p= 0.032). There were no statistically significant differences in terms of operating times or mean hospital stay. No recurrences, postoperative testicular atrophies, or indocyanine-green-related complications were recorded. Mean follow-up was 11.4 months. CONCLUSIONS: The use of indocyanine green for lymphatic sparing in the treatment of varicocele through the laparoscopic Palomo technique significantly reduces the incidence of postoperative hydrocele.

OBJETIVOS: Comprobar si el uso del verde de indocianina para la preservación linfática en la técnica de Palomo laparoscópico reduce la incidencia de hidrocele postoperatorio. MATERIAL Y METODOS: Se realizó un estudio comparativo de cohortes históricas incluyendo los pacientes tratados de varicocele mediante Palomo laparoscópico entre 2008 y 2023. Se dividieron en 2 grupos en función de la realización de linfografía con fluorescencia (verde de indocianina intratesticular). Se recogieron datos epidemiológicos, quirúrgicos, clínicos y complicaciones. Se realizó un análisis de contraste de hipótesis utilizando el programa SPSS. RESULTADOS: Se incluyeron 30 pacientes intervenidos de varicocele mediante la técnica de Palomo laparoscópico divididos en 2 grupos: en 13 se realizó preservación linfática y en 17 ligadura de vasos espermáticos sin preservación. La edad media en el momento de la cirugía fue de 14 años. Se identificaron 5 casos de hidrocele postoperatorio en el grupo sin preservación linfática. Uno requirió intervención quirúrgica para el tratamiento del hidrocele. No se identificó ningún caso de hidrocele en el grupo de la linfografía. La diferencia resultó estadísticamente significativa, p= 0,032. No hubo diferencias estadísticamente significativas en el tiempo quirúrgico ni en la estancia media. No se objetivaron recidivas, atrofias testiculares postquirúrgicas ni complicaciones asociadas al uso del verde de indocianina. El tiempo medio de seguimiento fue 11,4 meses. CONCLUSIONES: El uso del verde de indocianina para la preservación linfática en el tratamiento del varicocele mediante Palomo laparoscópico reduce significativamente la incidencia de hidrocele postoperatorio.

[Burns in adolescents]. / Quemaduras en adolescentes.

INTRODUCTION: The aim of this study was to know the epidemiology of burns in teenagers. PATIENTS AND METHODS: Burn patients over 11 years old admitted in our Institution in the last 10 years were included. Etiology, burn size, hospital stay, quirurgical interventions and long term sequelae were registered. RESULTS: One thousand and eight patients were admitted, 89 were over 11 years (8.8%), 70.7% were boys and 29.3% girls. Fire was the principal agent in 58 cases (65.1%), due to fireworks in 13 (22.4%), alcohol in 7 (12%), explosion of flammable containers (spray) in 4 (6.8%) and gasoline in 3 (5.2%). Fireworks injuries and spray explosions affected face and hand in 88% cases. The median hospital stay was 8 days after admission (1 to 90). 83.1% required surgical treatment with mean of 1.8 +/- 1.4 interventions and 21.3% had long-term sequelaes that required at least one surgical intervention. CONCLUSION: Fire is the main cause of burns in adolescents. Fireworks injuries represented a quarter of that lesions, and highlights paint spray explosions as new causative agents. Considering the high morbidity in this age group, with permanent functional and aesthetic sequelae, prevention campaigns are needed to reduce such accidents.

Endourological treatment of symptomatic ureteral stump posnephrectomy. / Tratamiento endourológico del muñón ureteral sintomático posnefrectomía.

INTRODUCTION: ureteral stump syndrome is defined as a recurrent urinary infection, low abdominal pain and haematuria in patients with a history of nephrectomy. Its incidence is low and the symptoms are non-specific. The aim of our paper was to present our results with endoscopic treatment of symptomatic ureteral remnants. MATERIAL AND METHODS: We performed a retrospective study of patients with ureteral remnant syndrome after nephrectomy treated in our centre between 2004 and 2015. We present a series of 10 patients. The patients were treated endoscopically with electrofulguration of the ureter and edges of the affected meatus, with subsequent injection of filler material into the suburetheral submucosa to aid in the coaptation of the ureteral remnant walls. RESULTS: The mean age at treatment was 2 years. The right ureteral remnant was treated in 6 patients and the left in 4. Seven meatuses were ectopic and 3 orthotopic. Follow-up was 8 years. After endoscopic treatment only 2patients relapsed. CONCLUSION: Endourological treatment of ureteral stump syndrome is a simple, safe, rapid and effective option that can be performed as an outpatient, for orthotopic and ectopic stumps. It does not compromise subsequent open resection of the ureteral remnant if required, and therefore we believe that it should be considered a valid alternative for the initial treatment of this disorder.

Endoscopic treatment of urethrodeferential reflux in children. / Tratamiento endoscópico del reflujo uretrodeferencial en niños.

INTRODUCTION: Urethrodeferential reflux is an underdiagnosed condition, and there is no consensus on its treatment. Our objective is to show our experience in the minimally invasive treatment of this disease using endoscopy. MATERIAL AND METHODS: We present 8 patients with recurrent suppurative orchitis due to urethrodeferential reflux treated endoscopically during the period 2008-2013. All patients presented unilateral orchitis. The minimum number of episodes of orchitis per patient prior to the operation was 3. The endoscopic treatment consists of ureteroscopy, locating the ejaculatory orifices and conducting an intraoperative contrast study to demonstrate the urethrodeferential reflux. Subejaculatory dextranomer/hyaluronic acid was subsequently injected in all the cases. RESULTS: The mean surgical time was 15min, and the procedure was outpatient for all patients. There were no postoperative complications, and the patients had good clinical progression. Only one case required a second injection of dextranomer/hyaluronic acid. The follow-up of these patients showed a complete resolution of the epididymitis and good testicular development, with a follow-up longer than 4 years in all cases. CONCLUSION: We propose this form of treatment as a minimally invasive, easily reproducible alternative that shows good long-term results in our small series of patients.

Tratamiento endourológico del muñón ureteral sintomático posnefrectomía / Endourological treatment of symptomatic ureteral stump posnephrectomy

Introducción: El síndrome del muñón ureteral se define como una infección urinaria recurrente, dolor abdominal bajo y hematuria en pacientes con antecedentes de nefrectomía previa. Su incidencia es baja y su sintomatología, inespecífica. El objetivo de nuestro trabajo es presentar nuestros resultados con el tratamiento endoscópico de los restos ureterales sintomáticos. Material y métodos: Realizamos un estudio retrospectivo de los pacientes que presentaban síndrome de resto ureteral tras nefrectomía y que han sido tratados en nuestro centro entre los años 2004 y 2015. Presentamos una serie de 10 pacientes. Los pacientes fueron tratados endoscópicamente con electrofulguración del uréter y de los bordes del meato afectado, con posterior inyección de material de relleno a nivel submucoso subureteral para favorecer la coaptación de las paredes del resto ureteral. Resultados: La media de edad al tratamiento fue de 2 años. El resto ureteral afectado fue derecho en 6 pacientes y en 4 fue el lado izquierdo. Siete meatos fueron ectópicos y 3, ortotópicos. El tiempo de seguimiento fue de 8 años. Tras el tratamiento endoscópico solo 2 pacientes recidivaron. Conclusión: El tratamiento endourológico del síndrome del muñón ureteral supone una opción simple, segura, rápida, ambulante y eficaz, tanto para restos ortotópicos como ectópicos. No compromete, si fuera necesaria, la posterior resección abierta del resto ureteral, por lo que creemos que debe considerarse como una alternativa válida para el tratamiento inicial de esta patología

Introduction: ureteral stump syndrome is defined as a recurrent urinary infection, low abdominal pain and haematuria in patients with a history of nephrectomy. Its incidence is low and the symptoms are non-specific. The aim of our paper was to present our results with endoscopic treatment of symptomatic ureteral remnants. Material and methods: We performed a retrospective study of patients with ureteral remnant syndrome after nephrectomy treated in our centre between 2004 and 2015. We present a series of 10 patients. The patients were treated endoscopically with electrofulguration of the ureter and edges of the affected meatus, with subsequent injection of filler material into the suburetheral submucosa to aid in the coaptation of the ureteral remnant walls. Results: The mean age at treatment was 2 years. The right ureteral remnant was treated in 6 patients and the left in 4. Seven meatuses were ectopic and 3 orthotopic. Follow-up was 8 years. After endoscopic treatment only 2 patients relapsed. Conclusion: Endourological treatment of ureteral stump syndrome is a simple, safe, rapid and effective option that can be performed as an outpatient, for orthotopic and ectopic stumps. It does not compromise subsequent open resection of the ureteral remnant if required, and therefore we believe that it should be considered a valid alternative for the initial treatment of this disorder

Tratamiento endoscópico del reflujo uretrodeferencial en niños / Endoscopic treatment of urethrodeferential reflux in children

Introducción: El reflujo uretrodeferencial es una entidad infradiagnosticada, no existiendo consenso en su tratamiento. Nuestro objetivo es mostrar nuestra experiencia en el tratamiento mínimamente invasivo de esta dolencia mediante tratamiento endoscópico. Material y métodos: Presentamos 8 pacientes con orquitis supuradas de repetición por reflujo uretrodeferencial tratados de forma endoscópica en el período de 2008-2013. Todos presentaron orquitis unilaterales. El número mínimo de orquitis por paciente anterior a la intervención fue de 3. El tratamiento endoscópico consistía en una uretroscopia con localización de los orificios eyaculatorios y un estudio de contraste intraoperatorio para demostrar el reflujo uretrodeferencial. Posteriormente se inyectó ácido hialurónico/dextranómero subeyaculatorio en todos los casos. Resultados: El tiempo medio de la cirugía fue de 15 min, siendo un procedimiento ambulante en todos los pacientes. No hubo complicaciones postoperatorias. Los pacientes presentaron buena evolución clínica. Solo un caso requirió el uso de una segunda inyección de ácido hialurónico/dextranómero. El seguimiento de estos pacientes mostró la resolución completa de los cuadros de epididimitis y un buen desarrollo testicular, con un seguimiento mayor de 4 años en todos los casos. Conclusión: Proponemos esta forma de tratamiento como una alternativa poco invasiva, fácilmente reproducible y que ha presentado buenos resultados a largo plazo en nuestra pequeña serie de pacientes

Introduction: Urethrodeferential reflux is an underdiagnosed condition, and there is no consensus on its treatment. Our objective is to show our experience in the minimally invasive treatment of this disease using endoscopy. Material and methods: We present 8 patients with recurrent suppurative orchitis due to urethrodeferential reflux treated endoscopically during the period 2008-2013. All patients presented unilateral orchitis. The minimum number of episodes of orchitis per patient prior to the operation was 3. The endoscopic treatment consists of ureteroscopy, locating the ejaculatory orifices and conducting an intraoperative contrast study to demonstrate the urethrodeferential reflux. Subejaculatory dextranomer/hyaluronic acid was subsequently injected in all the cases. Results: The mean surgical time was 15min, and the procedure was outpatient for all patients. There were no postoperative complications, and the patients had good clinical progression. Only one case required a second injection of dextranomer/hyaluronic acid. The follow-up of these patients showed a complete resolution of the epididymitis and good testicular development, with a follow-up longer than 4 years in all cases. Conclusion: We propose this form of treatment as a minimally invasive, easily reproducible alternative that shows good long-term results in our small series of patients

Quemaduras en adolescentes / Burns in adolescents

Objetivos. El objetivo de este estudio es valorar la epidemiología y etiopatogenia de las quemaduras en adolescentes. Pacientes y métodos. Estudio descriptivo retrospectivo de los pacientes mayores de 11 años ingresados en nuestro servicio por quemaduras en los últimos 10 años. Se registraron la etiología, superficie corporal quemada, estancia hospitalaria, intervenciones quirúrgicas y secuelas. Resultados. De un total de 1.008 pacientes ingresados por quemaduras, se incluyeron 89 con edad superior a 11 años (8,8%), siendo el 70,7% niños y el 29,3% niñas. El agente principal fue el fuego en 58 casos (65,1%), resultando secundario a explosión pirotécnica en 13 (22,4%), alcohol como combustible en 7 (12%), explosión de envases inflamables (spray) en 4 (6,8%) y gasolina en 3 (5,2%). La cara y las manos se vieron afectadas en las explosiones pirotécnicas y por spray de pintura en el 88% de los casos. La mediana de estancia hospitalaria fue de 8 días de ingreso (1 a 90). El 83,1% precisó de tratamiento quirúrgico con una media de 1,8 ± 1,4 intervenciones y el 21,3% presentaron secuelas que necesitaron al menos una intervención quirúrgica posterior. Conclusión. El fuego es la principal causa de quemadura en adolescentes, representando las explosiones pirotécnicas una cuarta parte y destacando la aparición de nuevos agentes causales, como la deflagración de botes de pintura (graffiti).Dada la alta morbilidad en este grupo de edad, con secuelas estéticas y funcionales permanentes, creemos conveniente la necesidad de campañas preventivas que contribuyan a disminuir este tipo de accidente (AU)

Introduction. The aim of this study was to know the epidemiology of burns in teenagers. Patients and methods. Burn patients over 11 years old admitted in our Institution in the last 10 years were included. Etiology, burn size, hospital stay, quirurgical interventions and long term sequelae were registered. Results. One thousand and eight patients were admitted, 89 were over 11 years (8.8%), 70.7% were boys and 29.3% girls. Fire was the principal agent in 58 cases (65.1%), due to fi reworks in 13 (22.4%), alcohol in 7 (12%), explosion of flammable containers (spray) in 4 (6.8%) and gasoline in 3 (5.2%). Fireworks injuries and spray explosions affected face and hand in 88% cases. The median hospital stay was 8 days after admission (1 to 90). 83.1% required surgical treatment with mean of 1.8 +1.4 interventions and 21.3% had long term sequelaes that required at least one surgical intervention .Conclusion. Fire is the main cause of burns in adolescents. Fireworks injuries represented a quarter of that lesions, and highlights paint spray explosions as new causative agents. Considering the high morbidity in this age group, with permanent functional and aesthetic sequelae, prevention campaigns are needed to reduce such accidents (AU)