The protective arm of the renin -angiotensin system may counteract the intense inflammatory process in fetuses with posterior urethral valves / O braço protetor do sistema renina-angiotensina pode contrapor-se ao intenso processo inflamatório em fetos com válvula de uretra posterior

Abstract Objective: Posterior urethral valve is the most common lower urinary tract obstruction in male children. A high percentage of patients with posterior urethral valve evolve to end‐stage renal disease. Previous studies showed that cytokines, chemokines, and components of the renin-angiotensin system contribute to the renal damage in obstructive uropathies. The authors recently found that urine samples from fetuses with posterior urethral valve have increased levels of inflammatory molecules. The aim of this study was to measure renin-angiotensin system molecules and to investigate their correlation with previously detected inflammatory markers in the same urine samples of fetuses with posterior urethral valve. Methods: Urine samples from 24 fetuses with posterior urethral valve were collected and compared to those from 22 healthy male newborns at the same gestational age (controls). Renin-angiotensin system components levels were measured by enzyme‐linked immunosorbent assay. Results: Fetuses with posterior urethral valve presented increased urinary levels of angiotensin (Ang) I, Ang‐(1‐7) and angiotensin‐converting enzyme 2 in comparison with controls. ACE levels were significantly reduced and Ang II levels were similar in fetuses with posterior urethral valve in comparison with controls. Conclusions: Increased urinary levels of angiotensin‐converting enzyme 2 and of Ang‐(1‐7) in fetuses with posterior urethral valve could represent a regulatory response to the intense inflammatory process triggered by posterior urethral valve.

Resumo Objetivo: A válvula de uretra posterior é a obstrução do trato urinário inferior mais comum em crianças do sexo masculino. Uma alta porcentagem de pacientes com válvula de uretra posterior evolui para doença renal em estágio final. Estudos anteriores mostraram que citocinas, quimiocinas e componentes do sistema renina-angiotensina contribuem para o dano renal em uropatias obstrutivas. Recentemente, descobrimos que amostras de urina de fetos com válvula de uretra posterior tinham níveis aumentados de moléculas inflamatórias. O objetivo deste estudo foi medir as moléculas de renina-angiotensina e investigar sua correlação com marcadores inflamatórios previamente detectados nas mesmas amostras de urina de fetos com válvula de uretra posterior. Métodos: Amostras de urina de 24 fetos com válvula de uretra posterior foram coletadas e comparadas com amostras de urina de 22 recém-nascidos saudáveis de mesma idade gestacional (controles). Os níveis dos componentes de SRA foram medidos por ensaio de imunoabsorção enzimática. Resultados: Os fetos com válvula de uretra posterior apresentaram níveis urinários aumentados de angiotensina (Ang) I, Ang-(1-7) e enzima conversora de angiotensina 2 em comparação com os controles. Os níveis de enzima conversora de angiotensina eram significativamente menores e os níveis de Ang II eram semelhantes nos fetos com válvula de uretra posterior em comparação com os controles. Conclusões: O aumento dos níveis urinários de enzima conversora de angiotensina 2 e de Ang-(1-7) em fetos com válvula de uretra posterior poderia representar uma resposta regulatória ao intenso processo inflamatório desencadeado pela válvula de uretra posterior.

An unusual presentation of urethral duplication presenting with chronic bladder retention, left scrotal transposition and left renal agenesis

ABSTRACT Introduction and objective Urethral duplication is a rare congenital anomaly, with roughly 200 cases reported in the literature (1). It is more frequent in males, with few cases reported in females. The clinical presentation differs according to the anatomical variant present. The duplication most commonly occurs in the sagittal plane with one urethra located ventrally and the other dorsally (2). Usually the ventral urethra is the more functional of both. Duplications occurring in the coronal plane are quite rare and they are usually associated with bladder duplication (3). The purpose of this paper was to present a video of a boy with an unusual urethral duplication form. Materials and Methods Patient was born premature due to oligohydramnios at 7 months-gestational age and he has initial diagnosis of hypospadia. Since then, he presented at least 7 febrile UTI and mother complained of difficult micturition and a presence of a mass at lower abdomen. Patient was referred to our institution and we identified urethral duplication with a glandar and scrotal meatus, palpable bladder and left penile-hemiscrotum transposition. US and CT-scan showed left kidney agenesis and overdistended bladder. VCUG and retrograde urethrography showed duplication, presence of contrast in the seminal vesicles and complete catheterizing of both urethras was not possible. Results The topic urethra was dysplastic and not patent to a 4Fr plastic tube so we were unable to access it endoscopically. We performed initially a Mitrofanoff procedure to allow CIC and treat chronic retention. Six months later, we assessed both urethras surgically and concluded that dorsal urethra was dysplastic after 3cm still in the penile area and scrotal urethra was not possible to be catheterized. We excised the ventral urethra because of dribbling complaints up to bulbar area and reconstructed the scrotal transposition, keeping the topic urethra for cosmetic issues. Patient had excellent outcome, performs CIC every 4 hours and has not presented further UTI episodes. Discussion and conclusion The urethral duplication is an anomaly that has multiple anatomical presentations. There are several theories about the etiology, but none can explain all types of presentations. There is also more than one rating available, and the Effmann classification is the most detailed. The case exemplifies this varied spectrum of anatomic urethral duplication. It resembles the urethral duplication type IIa-Y, however, ventral urethra meatus was located in penoscrotal area and both urethras were at least partially hypoplastic/dysplastic associated with obstruction and bladder retention. In determining how to best manage a patient with Y-type urethral duplication, the caliber and quality of the orthotopic urethra must first be assessed. Published reports suggest that best outcomes are those using the ventral duplicated urethra for the reconstruction (4). In this case, none of urethras were functional and a supravesical outlet channel had to be provided. The treatment of this condition requires an individualized planning and a vast technical knowledge of reconstructive surgery.

Urethral duplication type influences on the complications rate and number of surgical procedures

ABSTRACT Introduction: Urethral duplication is rare. Characterized by the presence of two urethral channels. This anomaly presents a great variety of clinical findings that depend on the type of duplication that often is associated with other anomalies. Material and Methods: We report thirteen boys with urethral duplication managed in our institution between 1988-2015. Clinical findings, associated anomalies, treatment of urethral duplication and our results are described. Patients were classified according to Effmann classification. Results: Mean patient's age was 38.3±34.7 months (3-136 months). Mean follow-up was 7.7±3.4 years (3y8m-14y2m). Type II A2 was the most common pattern (8/13 patients, 61.5%), followed by type IA (3/13 patients, 23%) and IIA1 (2/13 patients, 15.3%). The most frequent clinical manifestations were urinary tract infections (UTI) observed in 11/13 patients (84.6%) and anal urinary leakage, found in 7/13 patients (53.8%). Associated anomalies were found in 9/13 patients (69.2%). Required surgeries were 3.53±2.84 procedures per patient. Considering groups: Type IIA2 4.25±3.28, type IIA1 4±1.41 and type IA 1.33±0.57 needed procedures per patient. Complications rate were 0% for type IA, 50% for type IIA1 and 75% for type IIA2. Conclusions: Patients with incomplete duplication (type I A or I B) can totally be asymptomatic, with no need of surgical correction. Type IIA2 is the most complex form of duplication to correct and multiple procedures might be required because of the very hypoplastic orthotopic dorsal urethral tissue. Surgical treatment should be individualized and parents should be advised on complications and need of multiple surgeries according to urethral duplication type.

Imperfuração congênita do óstio uretral externo associada à persistência de úraco em bezerra Nelore: relato de caso / Congenital external urethral ostium imperforation associated to urachal persistence in Nelore calf: case report

A imperfuração uretral associada ou não à persistência do úraco é rara; quando concomitante, o animal mantém o fluxo urinário por via umbilical, entretanto, após o tratamento de correção da persistência do úraco, ocorre o armazenamento de urina, que pode culminar em complicações como bexigoma, hidroureter e ruptura vesical. Uma bezerra Nelore, com 20 dias de idade, foi atendida com persistência de úraco. Prescreveu-se a aplicação local de tintura de iodo a 10% durante cinco dias, e indicou-se retorno para obliteração cirúrgica caso não houvesse resposta à terapia proposta. Após 30 dias, o animal retornou com distensão abdominal, histórico de diminuição gradual do fluxo urinário, com ausência de micção via vaginal e discreto gotejamento de urina através do umbigo. Após diversas tentativas de cateterismo uretral sem sucesso, diagnosticou-se a imperfuração do óstio uretral externo. O exame ultrassonográfico revelou distensão vesical com aproximadamente sete litros de conteúdo, hidroureter e hidronefrose bilateral. Realizou-se a cistocentese e o esvaziamento vesical guiado por ultrassom e optou-se pela abordagem cirúrgica para criação do óstio uretral e correção do úraco persistente. Por meio de cistotomia, realizou-se a sondagem retrógrada da uretra e a perfuração da membrana que recobria o óstio uretral no vestíbulo vaginal, a fim de criar um novo óstio. A sondagem foi mantida por 10 dias, com o intuito de evitar estenose do óstio e, após 30 dias de pós-operatório, o animal recebeu alta com óstio uretral patente no vestíbulo vaginal.(AU)

Urethral imperforation associated or not with urachal patency is rare, when concomitant, the animal maintains urinary flow through umbilical via, but when the treatment is performed storage of urine occurs and can culminate in complications like bexigoma, hydrourether, and vesical rupture. A nelore calf with 20 days of age, was attended with urachal patency, conservative treatment with searing substance (10% iodine) was prescribed. Return for surgical treatment was recommended if no resolution was achieved. After 30 days, the animal returned with abdominal distension and history of gradual decrease in urinary flow without urination via urethra. Urethral catheterization was attempted, unsuccessfully, and sonographic evaluation revealed vesical distention with approximately seven liters of content, hydrourether and hydronephrosis. cystocentesis and vesical deflation was performed. Surgical approach of the bladder was performed and a new ostium for the urethra in the vaginal vestibule was created by retrograde via. Urachal was removed and urethral catheterization was maintained for 10 days. Following 30 days of pos operative procedure, the animal was discharged.(AU)

Complete duplication of the urinary bladder: an extremely rare congenital anomaly

A case of complete bladder duplication with urethra duplication, diphallus, anorectal malformation and rightsided renal agensis with ipsilateral gonadal agenesisis was reported because of its rarity. Possible deranged embryology resulting in these anomalies has been reviewed with relevant hypothesis. The patient underwent several investigations and undergoing multistage surgical intervention

Duplicación Uretral: Reporte de Caso / Urethral Duplication: Case Report

Preescolar, Masculino, 3 años 9 meses con antecedente quirúrgico de corrección de hipospadias 1er tiempo hace 2 años y que durante el 2do tiempo de corrección de hipospadias se encuentra incidentalmente una duplicación uretral tipo IB. Se confirma por medio de instilación de azul de metileno por uretra ventral y luego por medio de uretrocistoscopia. Se realiza la resección y cierre de uretra dorsal. Requiere de una dilatación uretral y está pendiente la corrección quirúrgica de una fistula uretrocútanea.

We report the case of a 3 year 9 month old boy who had a failed hypospadia correction two years prior to his second surgery when a IB urethral duplication was incidentally found. There are only 300 case reports of this published. The diagnosis was confirmed by instilling methylene blue through the ventral urethra, by urethero-cystoscopy. Resection and closure of the dorsourethra was performed. He required a urethral dilatation and developed aurethero-cutaneous fistula, which is pending surgical correction.

Chordee without hypospadias: operative classification and its management

Developing countries. To propose a operative classification of Chordee without hypospadias [CWH] with its management. Tertiary referral centre; Retrospective study from January 2000 to January 2011. Total 26 patients were classified peroperatively into sixtypes [A: Cutaneous chordee[rightwards arrow] Degloving skin and dartos [1/26]; B: Fibrous chordee[rightwards arrow] chordectomy [4/26];C: Corporocavernosalchordee[rightwards arrow] Corporoplasty +/- Urethral mobilization [4/26]; D: Urethral tethering with Hypoplastic urethra[rightwards arrow]Urethral mobilization +/- urethral reconstruction because of hypoplastic urethra [14/26]; E: Congenital short urethra[rightwards arrow] excision of urethra from the meatus and urethroplasty [2/26]; and F: Complex chordee[rightwards arrow] Degloving +/- Corporoplasty +/- urethroplasty [1/26 patients].The follow-up over 6 months to 9 years were analyzed. SPSS soft ware version 17.0 for Windows. The mean age of surgery was 5.33 +/- ?0.11 years. The success rate defined on uroflowmetry and voiding cystourethrography was 65.6%. The coronal urethra-cutaneous fistula developed in 26.9% [7/26] [including 7.7% [3/26] of associated metal stenosis]. The urethral stricture developed in 3.8% [1/26]. CWH needs stepwise surgical management. The operative classification may help in better understanding and management of this difficult entity. Meticulous tissue handling and urethroplasty is needed for good and promising results

Prune belly syndrome with urethral hypoplasia and vesico-cutaneous fistula: a case report and review of literature

Association between Prune belly syndrome [PBS] and urethral hypoplasia is an unusual condition. It is usually fatal unless there is a communication between the fetal bladder and the amniotic sac. We report a case of PBS with urethral hypoplasia and congenital vesico-cutaneous fistula in a male neonate. Patient underwent cutaneous vesicostomy and was discharged for close follow up of his renal function and for future reconstruction

Urethral duplication II-A Y type with rectal urethra: ASTRA approach and tunica vaginalis flap for first stage repair

INTRODUCTION: Urethral duplication is a rare congenital anomaly affecting mainly boys. Generally, the duplication develops on the sagittal plane; the accessory urethra may run dorsally or ventrally to the orthotopic one. We present a patient with urethral duplication in which the orthotopic urethra was patent in the penile segment but atresic in the bulbar and prostatic segment. The patient had urinary flow from the rectum and the ectopic urethra could be well identified by anal examination. MATERIALS AND METHODS: Age at surgery was 13 months. The procedure consisted of an ASTRA (anterior sagittal trans-ano-rectal) approach for dividing the urethra and rectum and was successful to move the urethra up to the perineal area. The rectum was reconstructed and the patient placed into a lithotomy position. A urethral catheter inserted in the penile urethra oriented us were the atresic urethra in bulbar area started. The scrotum was opened in the middle and the distance between the two urethral stumps proximal and distal defined the extension of no urethral tissue that consisted of 5 cm. We opened the right scrotal space and a tunica vaginalis flap was obtained and attached to the bulbar tissue for a two-stage urethroplasty strategy. RESULTS: Patient had a nice healing and the tunica vaginalis was nicely incorporated to the adjacent tissue, having the two urethral stumps well delineated. CONCLUSIONS: ASTRA approach in combination with a two-stage urethroplasty with tunica vaginalis dorsal flap proved to be an excellent combination for a rare case of urethral Y duplication having the main urethra into the rectum.

Quiste del conducto de Skene: presentación de un caso / Skene's duct cyst:: a case report

El quiste parauretral o quiste del conducto de Skene es una rara anomalía congénita descrita en neonatos de sexo femenino del cual no existían referencias en el Servicio de Neonatología anteriormente. Su incidencia se cifra entre 1 de cada 2.000 recién nacidos vivos. Se presenta un caso con este diagnóstico, atendido en el servicio con evolución favorable luego del tratamiento.

The paraurethral cyst or Skene's duct cyst is a rare congenital anomaly in female newborn of which there were no references in the neonatology service above. The reported incidence is 1 in 2,000 live births. It makes the presentation of a case with this diagnosis treated at the service with favorable evolution after treatment.

Bladder outlet obstruction in a 5 years boy

We report a 5 years old boy with bladder outlet obstruction secondary to a fibroepithelial polyp of prostatic urethra. The micturating cystourethrogram showed a filling defect in the posterior urethra. Cystourethroscopy revealed a polyp in the prostatic urethra proximal to the verumontanum. Transurethral resection was done and histopathology confirmed fibroepithelial polyp of the urethra

Meatobalanoplastia asociada a movilización de uretra para corregir hipospadias distales / Meatobalanoplastia associated with mobilization of the urethra to correct distal hypospadias

Objetivo: Demostrar que la meatobalanoplastia asociada a movilización, por liberación parcial o total de la uretra (MEBAMU) es una conducta técnico quirúrgica funcional y estéticamente útil para corregir hipospadias distales.Material y Métodos: 63 de 81 niños de entre 8 y158 m. de edad (promedio 37,4 m. mediana 25 m.) operados por el mismo cirujano entre los años 2000 y 2007 cumplieron con los criterios de inclusión. Es un estudio clínico prospectivo de tipo experimental, con controles históricos. Los detalles técnicos son descriptos minuciosamente. 15 (23,8%) eran hipospadias balánicas, 26 (39,7%) coronales y 22 (36,5%) subcoronales. 9 pacientes habían sido operados previamente, 8 con otras técnicas y 1 con la misma técnica. De acuerdo con las necesidades, en 18 pacientes la uretra se iberó parcialmente y en 45 totalmente (13 en un corto trayecto y 32 extensamente) . El seguimiento promedio fue de 33 m (6 a 99m). A 30 niños de 2 a 14 años de edad (Promedio 75,2 m) se les realizó uroflujometría, 36,6 m promedio después de operados. El análisis estadístico se realizó con software de SAS que considera un error de tipo I del 5% (alfa=0.05%). La comparación entre los grupos, cuando las variables fueron numéricas se realizó mediante el test de Wilcoxon Sun Run. Las variables nominales (cualitativas) mediante test de Chi cuadrado o Fisher Exact test. Resultados: Preponderó la liberación parcial de la uretra en las formas balánicas y la total en las coronales y subcoronales (p<0,01). 5 pacientes (7,9%) se complicaron, 2 fístulas y 3 estenosis. De los 9 pacientes con cirugías previas, 7 evolucionaron satisfactoriamente.

Pediatric surgery in Al-Qadisiya: report of rare cases

The aim of this paper is to report 3 rare pediatric surgery cases observed in Al-Qadisiyia: 1. A rare atypical parasitic rachiopagus parasitic twin, 2. Urethral diverticula and anterior urethral valves 3. Inguinal hernia with a persistent Mullerian duct syndrome and transverse testicular ectopia

[ female urethral diverticulum analysis of 27 cases]

To assess the clinical, radiological and therapeutic aspects of the female urethral diverticula through a series of 27 cases. Twenty seven women, with a mean age of 36.2 years [range 22 to 62 years] presenting a urethral diverticula, were treated between 1990 and 2008. Clinical examination made diagnosis in all cases. The urethral diverticula were excised via a transvaginal approach in all cases but one who refused surgery. twenty four patients had favorable immediate outcome. Diverticular recurrence was not reposted in any case. After a median follow-up of 22 months only three patients have some urinary urgency that was treated by anticholinergics. Urethral diverticular should be suspected in all cases of female lower urinary tract symptoms. The diagnosis is made by clinical examination and radiologic investigations. Transvaginal surgical excision gives the best results

Anterior urethral valves and diverticulum.

Anterior urethral valves with associated urethral diverticulum is a rare but important cause of infravesical obstructive uropathy in children. This condition can be a cause of significant morbidity and can even lead to end-stage renal disease. This rare condition should be included in the differential diagnosis while evaluating male infants with infravesical obstructive uropathy.

radiological puzzle: incidental genitography leading to peritoneal extravasation of contrast medium, during voiding cysto-urethrography, in a patient with urogenital sinus

While attempting cysto-urethrography and genitography in a nine-year-old female there was extravasation of the contrast medium to tHe peritoneal cavity during voiding cysto-urethrography [VCU] due to congenital adrenal hyperplasia [CAH]. Spillage of peritoneal contrast medium during VCU is extremely rare, even in patients with CAH and a persistent uro-genital sinus. Early fluoroscopic detection is essential, in recognizing the occurrence of spillage amid preventing further unnecessary injection of contrast medium into the peritoneal cavity

Seguimiento en la evolución de la uretroplastia tubularizada con incisión media de la placa uretral para corregir hipospadias / Follow up of tubularized urethroplasty with medial incision of urethral plate in the treatment of hipospadias

Objetivo: Reducir la tasa de complicaciones. Materiales y métodos: Desde diciembre de 2006 a abril de 2009 hemos seguido la evolución de 12 niños, que fueron operados en periodo de diciembre 2006 a agosto 2007, utilizando la técnica de Snodgrass como método de reparación primaria y secundaria para hipospadias de diferentes grados. Resultados: Un total de 12 niños de 4 meses a 7 años (promedio 2,7 años) recibieron reparación con la técnica de Snodgrass, 8 niños no habían tenido cirugías previas de reparación, pero los restantes 4 iban por el segundo procedimiento, el neo tubo uretral fue tubularizado usando una sutura corrida de poliglatina 6-0, el promedio de estancia hospitalaria fue de 2,9 días, la sonda transuretral permaneció en promedio 5,25 días. La tasa conjunta de complicación fue de 8,3 por ciento, incluyó una fístula, el seguimiento de los 12 niños ha sido de 1 año, 9 m a 2 años, 5 m. Conclusión: Nuestra experiencia con la uretroplastia tubularizada con incisión en la línea media de la placa uretral, reportó baja complicaciones, a pesar de previas cirugía en cuatro pacientes.

Objective: To reduce the rate of complications. Materials and methods: From December 2006 to April 2009 we have followed the evolution of 12children, who were operated in between December 2006 and August 2007, using the technique of tubularized incised plate (Snodgrass) as the primary or secondary procedure for hypospadias in 12 boys; 4 months to 7 years old (mean 2.7 years). Results: A total of 12 boys underwent a Snodgrass repair for sub coronal, distal penile, mid-shaft and scrotal hypospadias. A total of 8 boys (66.6 percent) from 4 months to 4 years (mean 1 year) had no previous repairs, while 4 patients (33.3 percent), from 4 to 7 years old (mean 6 years) had previous repair. The neourethra was tubularized using locking 6-0/5-0 polyglactin sutures. Average hospital stay was 2.9 days. The stent was left an average of 5.25 days. The overall complication rate was 8.3percent, complication include durethrocutaneous. fistula. Follow-up of 12 children after surgery ranged from 1 year 9 m to 2 years 5 Conclusion: Our experience with TIP shows the versatility of the procedure. Incision and tubularization of the urethral plate was possible despite previous surgery in 4 patients.

Distal hypospadias; Barcat-Redman urethroplasty

To assess the efficacy, safety and complication of Barcat-Redman urethroplasty technique in the management of distal hypospadias. Prospective study was completed at Urology Department, Services Hospital Lahore and Larkana from 1998 to 2007. Fifty patients of distal hypospadias were selected from the Urology Department of Services Hospital Lahore and Larkana for Barcat-Redman urethroplasty technique. Age of the patients range from 5 to 25 years. The mean age was 11 years. Forty [80%] patients belonged to urban areas while 10 [20%] were of rural areas. All the patients presented with dystopia of external urethral meatus and chordee [ventral curvature] while 25 [50%] presented with misdirected stream, 3 [5%] spraying of urine and 3 [5%] narrow stream. The subcoronal type of distal hypospadias was commonly seen in our study. Forty [80%] patients had subcoronal and 10 [20%] distal penile urethral opening. Following barcat-redman technique 35 [70%] patients had good result and 8 [16%] patients were declared as fair result while 4 [14%] declared failure. The overall morbidity rate was 30% while hospital stay was 3 days. Barcat-Redman urethroplasty technique is simple, less time consuming and has success rate for the management of Distal hypospadias

Uso de injertos libres -Snodgraft- en corrección de hipospadias complicadas en un sólo tiempo / Use of free grafts -Snodgraft- in complicated hypospadias repair in a single stage

Objetivos: La incisión y tubularización de la placa uretral "Snodgrass" es la técnica más utilizada en nuestro medio en la corrección de hipospadias, tiene limitantes cuando la placa uretral es pobre, estrecha o hay cicatriz de cirugías previas. Se han desarrollado técnicas nuevas como la ampliación de la placa uretral nativa con un injerto libre en el fondo de la misma y cierre primario de ésta; técnica denominada "Snodgraft" (Snodgrass + Graft/Injerto) ó Inlay. Para nuestro conocimiento en nuestro país existe poca o ninguna experiencia en el uso de injertos libres como parte integral en la corrección de hipospadias. Es este el primer trabajo realizado en Colombia. Material y Métodos: Se incluyeron todos los pacientes a quienes se les realizo corrección de hipospadias con técnica Snodgraft desde marzo 2006 hasta abril 2008 en la Clínica Infantil de Colsubsidio y Hospital Universitario San Ignacio en Bogotá Colombia. Divididos en dos grupos: A: Sin cirugía previa. B: Cirugía previa de hipospadias fallida. Se consideró éxito los que cumplieron los objetivos quirúrgicos de: Ausencia de fístulas, meato glanular, chorro anterógrado, buen resultado cosmético. Se hizo registro fotográfico pre y post quirúrgico. Análisis de Resultados: Se incluyeron 17 pacientes, edad promedio 4.2 años (rango:1.25 - 15). hipospadias del tercio medio: 75 por cien grupo A y 77por cien en el B. Se utilizo mucosa prepucial en el 100 por cien del grupo A. Mucosa oral en 78 por ciendel grupo B. Se utilizo colgajo pediculado de dartos sobre la línea de sutura de la neo uretra en todos los pacientes de ambos grupos excepto uno del B que se cubrió con túnica vaginal. 16 pacientes se derivaron con catéter uretral siliconado y uno con cistostomía. 6 complicaciones (35.3 por cien ), 2 Fístulas (11.7 por cien) que requirieron nueva cirugía, las 4 restantes: estrechez del meato (2), fístula proximal, necrosis parcial de piel, resolvieron sin intervención quirúrgica. Finalmente luego de la segunda...

Validation of initial serum creatinine as a predictive factor for development of end stage renal disease in posterior urethral valves.

OBJECTIVE: The aim of this study was to determine the value of initial serum creatinine in prediction of End-stage renal disease (ESRD) in children with posterior urethral valves PUV. METHODS: In this retrospective study, patients diagnosed with PUV admitted in Aliasghar Children's Hospital in Tehran, Iran from 1991 through 2001 were studied. Based on the development of ESRD (need for dialysis) they were classified in two groups and their demographics, initial presentations, laboratory data, imaging findings and outcomes were reviewed and compared. RESULTS: Thirty six male patients with PUV, treated with valve ablation (13), vesicostomy (13), or high ureterostomy (10) were followed for developing ESRD. Sixteen of the 36 patients developed ESRD at their last follow-up. There was no significant difference in age at initial presentation, presence of urinary tract infections, incidence of vesicoureteral reflux, renal dysplasia or type of primary surgical intervention between the patients with or without ESRD. Patients who progressed to ESRD had serum creatinine concentration > 1.0 mg/dl at diagnosis as compared to those without ESRD (P = 0.001). CONCLUSION: Initial serum creatinine is a valuable factor for prediction of renal outcome in patients with PUV.