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ABSTRACT: To evaluate the efficacy of a third endoscopic injection to correct vesicoureteral reflux (VUR).
This was a prospective study of 605 patients, of whom 42 (6.4%), involving 44 (4%) ureteral units, received a third injection. The results were analysed regarding VUR grade and aetiology, substance used, volume, location and morphology of the mound, presence of poor prognostic factors, the urologist's experience, and complications.
The treatment resolved the VUR in 38 (86.4%) units, 22 of primary cause (91.6%) and 16 with anatomical/functional abnormalities (80%) (no significant difference; P = 0.26). There was also no significant difference in success rate with regard to the substance injected (P = 0.23), the degree of VUR (P = 0.76) or the volume injected (P = 0.17). The success rate was higher (96.9%) if a less experienced urologist had performed the previous procedure versus a more experienced urologist (54.5%), and this difference was significant (P < 0.005). There was one complication (haematuria) (2.3%).
Third treatment presents a similar efficacy to first and second treatments, with a very low rate of complications, and could be indicated before open surgery.
Journal of pediatric urology 03/2011; 7(6):650-3. · 1.38 Impact Factor
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ABSTRACT: Polyps in the urinary tract are a rare entity in infants and children. The most frequent location when they appear is the ureter. These benign lesions with no malignant potential have a varied form of presentation and in most cases must be distinguished from malignancy. The suspected diagnosis is due to urinary obstruction; nevertheless radiological evidence played a key role in the final diagnosis. The management is as less invasive as possible, with endoscopy resection or minimally invasive surgery.
Cirugía pediátrica: organo oficial de la Sociedad Española de Cirugía Pediátrica 01/2011; 24(1):59-61.
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Actas urologicas españolas 03/2010; 34(3):299-301. · 0.46 Impact Factor
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ABSTRACT: Urethral polyps are a rare pathology that is usually diagnosed in childhood hematuria and obstructive urinary symptoms are the most common findings and transurethral resection is the best choice of the treatment. We report three cases, a 6-years-old boy and 9-years-old boy diagnosed and treated of posterior urethral polyp after showing hematuria and obstructive urinary symptoms, and a 2-years-old girl that showed to prolapse of urethral polyp.
Cirugía pediátrica: organo oficial de la Sociedad Española de Cirugía Pediátrica 01/2010; 23(1):7-9.
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ABSTRACT: The case is presented of a 10-year-old HIV+ male with renoureteral pain, who developed an obstructive uropathy with renal function impairment and required endoscopic placement of a ureteral stent. Certain aspects of the epidemiology, clinical presentation, diagnosis, treatment and prevention are discussed.
Journal of pediatric urology 01/2008; 3(6):512-3. · 1.38 Impact Factor
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ABSTRACT: Retrospective study of 124 patients (average age: 3.8 years) with midpenile hypospadias: 48.3% (60 children), distal penile: 45.9% (57) and coronal 5.6% (7), of which the 25.8% (16) presented ventral curvature and the 4.8% (6) resulting from the complication of another previous technique. All of them were operated according to Snodgrass' technique, removing the catheter between the 6th and 7th day in most of them. The global rate of complications was of 12%: 9 fistulae (7.2%) and 6 meatal stenosis (4.8%). Aesthetic result was satisfactory in all cases, getting glans covered by foreskin in 57.3%.
Actas urologicas españolas 06/2007; 31(5):528-31. · 0.46 Impact Factor
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ABSTRACT: We present 3 new cases of urethral parameatal cysts in paediatric age. Literature is reviewed and histological data and ambulatory management are discussed.
Actas urologicas españolas 02/2007; 31(1):61-3. · 0.46 Impact Factor
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ABSTRACT: Torsion of a cryptorchidid testicle presents a non-specific symptomatology. Clinical suspicion indicates surgical exploration, irrespective of Doppler ultrasound with its inherent false negative results. With regards to treatment, an orchiectomy is performed when the testis is necrotic. Management of the contralateral testis is controversial. Our policy is not to fix them systematically because we believe that a healthy education of parents and children is more important, so as to obtain an earlier diagnosis of a future torsion.
Actas urologicas españolas 02/2007; 31(1):49-51. · 0.46 Impact Factor
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ABSTRACT: [corrected] To review urethrorrhagia cases, the need of complementary test, its management and natural history.
A retrospective analysis was carried out for the 12 patients who suffered from urethrorrhagia, consecutively diagnosed in our department. Parameters as age, and micturitional habit were evaluated. In this way, we described the diagnostic techniques used, assessment and the follow-up of each patient.
All cases correspond to male children with an average age of 8.7 years (range: 18 months-14 years). Urethrorrhagia appears in 100% of the patients, episodes which were daily in 58.4%. 33% (4/12) of them also present other micturitional symptoms. 75% (9/12) had a lazy micturitional habit. Among the urological backgrounds we found: 1 patient was circumcised 3 years ago, a meatotomy was done in other due to meatus stenosis 2 years before, and a last one had an electrocoagulation of a urethral polyp just 1 month before. 83.4% (10/12) of urine cultures were negative. An urethrocystoscope was done in 9 patients finding a verum hypertrophy in 4, inflammatory changes next to membranous urethra in 3, scar at the bulbar urethra in 1 and in a last one no abnormalities were found. Out of 8 patients with lazy micturitional habit, 75% (6/8) resolve spontaneously once they correct their habits after a mean follow-up of 9 months. Only 2 patients needed surgery (TUR). In the other 2 patient, symptoms.
Urethrorrhagia in childhood is a benign condition in most cases, which is almost always cured spontaneously during the first 2 years of follow-up. Radiological studies as well as endoscopic procedures are unnecessary in the early management of these patients thus being relegated to recurrent or persistent bleeding.
Actas urologicas españolas 02/2007; 31(1):29-32. · 0.46 Impact Factor
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ABSTRACT: Testicular microlithiasis (TM) represents an uncommon occurrence at paediatrics with a radiological incidence between 0.16 to 0.6% according to reports. The greater use of ultrasound as well as the availability of high-frequency probes has increased the number of incidental TM being diagnosed.
From January 1998 to October 2002 seven children, aged 9 to 13 years (average 11 years and 1 months), were diagnosed of MT in our department. Sonographic appearance was hyperechogenic multiple small foci of 1-3 mm without acoustic shadowing of the testicular parenchyma.
To evaluate sonographic patterns of TM, their associations, clinical consequences and to determine their management.
All children were asymptomatic and the reasons for the ultrasound were: cryptorchism (3), short height (1), gynecomastia (1), varicocele (1) and scrotum trauma (1). It should be noted that 3 of the cases showed bilateral TM. Out of 10 testicles with TM, 8 met classic testicular microlithiasis (CTM) criteria (at least one image that showed five or more microliths in either or both testes) and 2 had limited testicular microlithiasis (LTM) (to have at least one microlith). Clinical and radiological follow-up is being performed annually, ranging from 18 months to 6 years, during which there hasn't been progression or regression in the number of TM or in their distribution. In none of these cases there has been shown a related testicular cancer.
In other broad reviews it has been shown that there is no evidence to suggest that the TM have to be considered as premalignant lesions by themselves. However, the association among TM and cancer exists. Because of that, and due to the lack of consensus, we recommend annual clinical and radiological (ultrasound) follow-up until puberty, and thereafter the patient should be informed of unknown natural history of this condition. We do not recommend more invasive procedures such as biopsy except: 1) apart form the TM there is a change in the echogenicity or 2) if there is a change in the number or distribution of the TM.
Actas urologicas españolas 02/2007; 31(1):33-7. · 0.46 Impact Factor
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ABSTRACT: Since the beginning of the application of the RVU treatment, the use of the ultrasound was used taking into account two main indications/symptoms: a) identification of the complications; b) assessment of the result (visualization of the implanted material and the presence of the "uretheral jet" by means or through/of ecodoppler-color).
To determine the value of the ultrasound in the assessment of the result of the endoscopic treatment of the RVU and in the detection of its complications.
From 2001-2002 we have carried out the endoscopic treatment to an overall of 261 ureteral units of all degree and etiology. 246 were assessed post-operation with an ultrasound per month and all of them were evaluated with a cistography after 3 months. In a random sample of 92 units, the result of the isotopic cistography has been compared with the visualization of the implanted material in the bladder; and in a random sample of 56 units, the result of the isotopic cistography has been compared with the presence of ureteral jet in the study with ecodoppler-color after moisturizing of the patient. In order to do, we have done two corresponding comparative charts 2 x 2 and we have calculated the Sensibility and Specificity of the tests, as well as their predictive positive and negative values, the degree of similarity of both tests with the Kappa index, and the degree of statistical relevance with Chi squared.
The ultrasound did not show significant changes if compared to previous studies in 213 units (86,58 %) although in 5 patients an ectasia has been identified as attributed to the treatment. 3 of this patients have developed renoureteral pain, and in 2 pain has spontaneously disappeared as shown in later tests. The S and the E of the presence of implanted material is 94% and 10%respectively and its VPP and VPN of 80% and 10% and estadistical. The S and E of the jet visualization is 82% and 30%, with a VPP of 84% and a VPN of 27%, a level of statistical relevance of 0.836 and a degree of correlation of 0.121.
Ultrasound is not a useful technique in the assessment of the result of the endoscopic treatment of the RVU. The role it plays in the assessment of complications is a small one and its use is only indicated to confirm the suspicion of ectasia in those patients that present renoureteral pain.
Actas urologicas españolas 05/2006; 30(4):402-5. · 0.46 Impact Factor
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ABSTRACT: Nowadays, around 1% of children suffer from vesicoureteral reflux (VUR), which represents a risk factor for long-term kidney damage. In the last decade, development in this field has shown that subureteric endoscopic injection of bulking agents for childhood VUR is an acceptable alternative unlike long-term antibiotic prophylaxis and open surgery.
To establish the complications of childhood VUR endoscopic treatment.
A retrospective analysis was carried out for every patient treated endoscopically in our department from January 1999 to September 2003, with a total amount of 516 implants of submucous bulking agents. All patients were assessed with an ultrasound as a first diagnostic technique so as to establish the complications associated with it, especially ureteral obstruction and injected agent migration.
Out of 516 cases, Macroplastique was used in 455, Deflux in 44 and Polytef in 17. 10 patients (1.9%) (5 girls/ 5 boys), with ages ranging from 15 months to 11,4 years, presented some kind of complications (Macroplastique was used in 8cases and Deflux in 2). Among them, 5 were remarkable due to an ureterohydronefrosis, 2 of which needed a nephrostomy. 3 patients presented an implant migration, 1 epididymitis and 1 bladder edema.
Endoscopic bulking agent injection has become a safe alternative to open surgery in childhood VUR management.
Actas urologicas españolas 03/2006; 30(2):170-4. · 0.46 Impact Factor
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ABSTRACT: Renal transplantation in children with bladder dysfunction carries a risk for the renal graft. We report our experience with transplantation in 15 patients 6 to 18 years old with severe abnormalities of the lower urinary tract.
A total of 18 renal transplants were performed in 15 children with bladder dysfunction secondary to myelomeningocele (3), occult spina bifida (1), malformation/agenesis of the sacrum (5), posterior urethral valves (4), female hypospadias (1) and bladder exstrophy (1) between 1979 and 2003. Urological surgery was performed before transplantation in 14 cases-7 bladder augmentations, 5 incontinent urinary conduits/reservoirs and 2 vesicostomies. Voiding was maintained by intermittent catheterization in 9 cases and incontinent ostomies in 6. Graft implantation was performed by extraperitoneal route with ureteral anastomosis to the native bladder in cases of bladder augmentation. Immunosuppression consisted of triple therapy with polyclonal/monoclonal antibodies.
Urological complications consisted of urethral obstruction due to mucus hypersecretion (1), urinary fistula (1), ureterovesical obstruction (1), stone formation (3), urinary tract incrustation by Corynebacterium urealyticum (1) and pyelonephritis (2). Graft survival rates at 1 and 5 years were 77% and 62%, respectively, with a median of 79 months (95% CI 51 to 107). Three graft losses were related to urological disease.
Renal transplantation in children with severe bladder dysfunction can achieve similar results to those obtained in the general population. Meticulous selection of patients and surgical reparative techniques ensuring voiding and adequate control of urinary infections are mandatory. Augmentation cystoplasty and intermittent catheterization are appropriate techniques currently used for achieving this outcome.
The Journal of Urology 02/2005; 173(1):226-9. · 3.75 Impact Factor
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ABSTRACT: Hemorrhagic infarction of the testicle is an unusual occurrence in the newborn infant. It usually develops as a consequence of torsion of the spermatic cord. We report a case of global testicular infarction in a newborn associated with a tense hydrocele.
Actas urologicas españolas 06/2004; 28(5):393-5. · 0.46 Impact Factor
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ABSTRACT: Berdon syndrome is a rare congenital malformation that consists in megacystis and severe intestinal malformations that condition the prognosis in most of the cases. We report the three cases diagnosticated between 1976-2003. Diagnosis, therapeutics aspects and evolution are discussed.
Actas urologicas españolas 06/2004; 28(5):405-8. · 0.46 Impact Factor
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ABSTRACT: Intrathoracic ectopia is an unusual ectopia that represents less than 5% of renal ectopia. The association of a duplex system and an intrathoracic renal ectopia is very rare. We report a case of a girl affected from these two anormalities, being the first case published in the literature reviewed. Presentation, diagnosis and therapeutic aspects are discussed.
Actas urologicas españolas 04/2004; 28(3):249-51. · 0.46 Impact Factor
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ABSTRACT: Epidermoid cysts of the testis are rare in children (3% of all the testicular tumors). Bilateral appearance has only been described in the pediatric age in 2 cases and none associated to Klinefelter's syndrome. We present, for our knowledge, the first case of bilateral epidermoid testicular cyst associated to klinefelter's syndrome in a boy, highlighting its management and therapeutic approach. We analyze the different kinds of treatment.
Actas urologicas españolas 11/2003; 27(9):742-4. · 0.46 Impact Factor
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ABSTRACT: Cutaneous vesicostomy (CV) is a choice temporary urinary diversion technique for patients with upper urinary tract (URT) dilation, secondary to vesical o infravesical disease. The objective of this study is to share our experience in children undergoing such diversion, analysing its efficacy to prevent urinary infections, improve or resolve the ureterectasia, and stabilise or improve renal function; in short the functional and morphological recovery of URT.
43 children, mean age 2.5 years (range: 1 month-14 years) with ureterohydronephrosis grade IV-V, persistent urinary infection and/or renal function impairment underwent cutaneous vesicostomy (Blocksom's technique in 36 and Lapides' procedure in the rest). Thirty subjects had neuropathic bladder (26 with secondary vesicoureteral reflux), 7 massive primary vesicoureteral reflux, and 6 posterior urethral valve.
All children (100%) with neurogenic bladder (30 cases), showed improvement of ureteral-pyelic-calyceal ectasia after the diversion, and 90% improved renal function with disappearance of vesiculoureteral reflux in 65%. Augmentation cystoplasty with gut was performed in 12 patients during vesicostomy closure, using Mitrofanoff's type diversion in 5 of them. The same continent diversion with cecal appendix was used in another 7 children as the only procedure. The remaining 11 children still retain their vesicostomy. In 5 of the 7 children with primary vesicoureteral reflux, the reflux disappeared and so the vesicostomy was closed. Reflux correction during the same surgical procedure was required for the other 2 children. Of the 6 children with posterior urethral valves, 2 received a renal transplant, one is in waiting list and the rest (50%) maintain an acceptable renal function. In the first year of follow-up, 4 patients developed symptomatic urinary infection that later disappeared. The rest had occasional asymptomatic bacteriuria that required no treatment. Complications included vesical prolapse due to ostomy in 4 patients, lithiasis in 3 and stomal stenosis in 2.
We consider vesicostomy to be the choice urinary diversion technique in cases of common section obstruction and/or non-obstructive ureterohydronephrosis in new-borns who do not improve with conservative treatment.
Actas urologicas españolas 02/2003; 27(1):33-8. · 0.46 Impact Factor
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ABSTRACT: A case of lobar nephronia in a child is presented.
Herein we describe a case of acute lobar nephronia in a 10-year-old boy. The clinical, diagnostic and therapeutic aspects are discussed.
Acute lobar nephronia or acute focal bacterial nephritis is an uncommon form of pyelonephritis that can affect both adults and children, although few cases have been reported in children. Imaging techniques are necessary for diagnosis and to distinguish it from other conditions, such as abscess or renal masses that require a different treatment. Ultrasound is the imaging technique of choice in the diagnosis and follow-up of lobar nephronia.
Archivos españoles de urología 05/2000; 53(3):249-51.
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ABSTRACT: Sensitization to latex has become a major problem in children with spina bifida. Life-threatening reactions may occur in these patients, therefore the search of latex sensitization must be an active task in all of these children.
To design an approach for the diagnosis of latex sensitization in children with spina bifida.
We studied 100 consecutive unselected patients. Skin prick tests with a commercial latex extract were performed, latex-specific serum immunoglobulin (Ig) E was determined by CAP test, and risk factors were studied. Originally, patients with an area of latex skin test > 50% of the area of histamine and/or CAP class > or = 3 were considered sensitized to latex. Diagnostic tests were also performed in a control group of 51 atopic and nonatopic children.
After performing a receiver-operating characteristics curve for both tests we recommend skin tests > 25% of the area of histamine (sensitivity - SEN = 79%, specificity - SPE = 100%, positive predictive value - PPV = 100%, negative predictive value - NPV = 90%), or CAP class > or = 2 (SEN = 88%, SPE = 100%, PPV = 100%, NPV = 94%) as diagnostic cut-off points. The anamnesis had a SEN of 44% for diagnosis, and a SPE of 100%. Latex sensitization was associated with more than 5 operations (OR = 8, 95% CI = 3-21.3), a personal history of atopy (OR = 11.5, 95% CI = 2.3-57.1), and serum total IgE > or = 2 z-units (OR = 4, 95% CI = 1. 6-10).
For the routine evaluation of children with spina bifida, we propose a diagnostic algorithm with skin prick tests as a first step and CAP second.
Clinical & Experimental Allergy 03/2000; 30(2):264-9. · 5.03 Impact Factor
