Lesión quística peneana tras administración intramuscular de testosterona / Penile cystic lesion after intramuscular testosterone injection

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Reducción de la estancia hospitalaria en el tratamiento quirúrgico de las hidronefrosis en la infancia / Reduction of the hospital stay in the surgical treatment of the hydronephrosis in children

La cirugía de las hidronefrosis representa un acto relativamente frecuente en la infancia. No existe acuerdo sobre la necesidad o no de utilizar drenaje, ni el tipo a emplear, decisiones que repercuten directamente sobre la estancia hospitalaria del paciente. Dada la relevancia de ésta sobre los costes del sistema sanitario, el objetivo del estudio es mostrar la reducción de los días de ingreso en esta patología variando el tipo de drenaje empleado. Material y Métodos. Durante 1 año y 3 meses hemos intervenido 14 niños con hidronefrosis obstructiva mediante pieloplastia tipo AndersonHynes y derivación interna con catéter doble J del n° 3 ó 4 Fr en vez de nefrostomía y tutor ureteral que era el sistema empleado hasta ahora. Predominó la afectación izquierda con 10 riñones y la edad de diagnostico varió de r.n a 11 años. Analizamos la disminución de los días de estancia hospitalaria y las complicaciones presentadas con este drenaje. A partir del 15 día del postoperatorio practicamos cistoscopia, con ingreso en el hospital de día, para retirar el catéter, dando una encuesta de satisfacción a los padres que fue devuelta en el primer control. Resultados. En 13 enfermos se dio el alta a los 2 días y en uno a los 3 días. Hubo 3 complicaciones, 2 menores y una mayor (ascensión del doble J que precisó su retirada con ureterorenoscopia, lo que supuso un ingreso adicional de un día). La reducción de los días de ingreso, con respecto al método de nefrostomía y tutor, varió entre 7 y 8, lo que representa un ahorro importante de dinero. El resultado de la encuesta arroja que la utilización del doble J ha sido considerada satisfactoria por los padres. Conclusión. Creemos que el empleo del catéter doble J representa una mejora que ahorra tiempo, da seguridad y disminuye las molestias postoperatorias, aunque precisa de otro procedimiento, cistoscopia, para su extracción. Últimamente la aparición de catéteres doble J con un extremo prolongado, que sale al exterior tipo nefrostomía, evita la cistoscopia (AU)

[Reduction of the hospital stay in the surgical treatment of hydronephrosis in children]. / Reducción de la estancia hospitalaria en el tratamiento quirúrgico de las hidronefrosis en la infancia.

UNLABELLED: A Hydronephrosis operation represents a relatively frequent surgery in childhood. There is not agreement about the necessity of using drainage neither on the type to use, decisions that rebound in the patient's hospital stay. The objective of the study is to show the reduction of the days of stay according to the type of drainage used. MATERIAL AND METHODS: We present 14 children diagnosed of hydronephrosis operated on by Anderson-Hynes technique with an internal drainage double J type no 3 or 4. There were left side predominance (10 kidneys). Age of diagnosis varied from 0 to 11 years. We analysed the decrease of the stay with regard to the system that we used previously, nephrostomy drainage and stent, as well as the presence of complications related with the drainage. A cystoscopy was performed fifteen days later, in ambulatory way, to remove the catheter. A questionnaire of satisfaction was requested to the parents. RESULTS: Thirteen patients abandoned the hospital 2 days postoperatively and 2 three days postoperatively. There were 3 complications, being 2 minor and 1 mayor (double J ascension removed by ureteroscopy and an additional one day stay hospital). The reduction of the stay with regard to the traditional method varied between 7 and 8 days what represents an important saving of costs. In the questionnaire, the methods has appealed to the parents. CONCLUSION: We believe that the placement of a double J catheter represents an improvement that saves time and diminishes nuisances to patients, although a cystoscopy procedure is necessary for its removal. The double J catheters with a straight prolonged end, like a nephrostomy tube, recently in the market can avoid this last procedure.

[Is it necessary to use an isotopic diuretic renogram in grade II pyelocaliceal dilatations diagnosed with ultrasonography?]. / Es necesario efectuar un renograma isotópico diurético en las dilataciones pielocaliciales grado II ecográfico?

PURPOSE: The increasing number of ultrasonographically detected asymptomatic, renal dilations have caused a lot of explorations to be performed in these patients. The Society of Fetal Urology proposed a four grades classification of echographic renal dilations and renographic studies are recommended in grades II to IV. However we have observed that grade II dilations don't evolve to obstruction. The aim of this work is to evaluate the obstruction rate in this group of patients, and the necessity or not of practising diuretic renography. MATERIAL AND METHODS: We studied 42 children diagnosed of grade II renal dilation during a 1.5 year period. Left side was more frequently affected, 23 cases, 7 cases were bilateral what means 49 affected renal units. There was a male predominance (69%). Mean age at diagnosis was 2 months (0 to 36 months). Seventy nine per cent were prenatally diagnosed. RESULTS: The MAG-3 renal scan showed 48 unobstructed renal units and 1 obstructed. The F-15 variant was made in 15 cases by a doubtful curve or retarded elimination. The patient with obstructive curve presented an 15 mm renal pelvic diameter echographically measured and the intravenous urography showed a higher dilation being operating on. The mean time follow up was 23.5 months (13 to 53 months) without any change. CONCLUSION: Grade II pielocalicial dilations with renal pelvis lesser than 15 mm can be echographically controlled without renal scan. It should be performed only if renal dilation increases.

¿Es necesario efectuar un renograma isotópico diurético en las dilataciones pielocaliciales grado II ecográfico? / Is it necessary to perform a diuretic isotopic renography in grade II pelocalicial dilations diagnosed by means of ultrasound?

El incremento de riñones dilatados detectados por ecografía (ECO), la mayoría asintomáticos, ha provocado que estos niños acudan a consulta para valoración y tratamiento adecuado. La Sociedad de Urología Fetal ha clasificado las dilataciones renales, mediante ECO, en IV grados, recomendándose estudios renográficos en los grados II, III y IV. Desde hace años observamos que las dilataciones grado II no suelen presentar obstrucción, por lo que el objetivo del trabajo consiste en valorar la incidencia de obstrucción en este grupo y, por lo tanto, la necesidad o no de efectuar renograma isotópico diurético. MATERIAL Y MÉTODOS: Durante 1,5 años estudiamos 42 niños con dilatación pielo-calicial ecográfico grado II, mediante renograma isotópico diurético tipo MAG-3. Hubo mayor afectación del lado izquierdo con 23 casos y 7 fueron bilaterales, lo que totaliza 49 unidades renales dilatadas. Predominaron los varones (69 por ciento) y la edad media al diagnóstico fue de 2 meses (0 a 36 meses). Un 79 por ciento presentó diagnóstico prenatal. RESULTADOS: El MAG-3 mostró 48 riñones con curva no obstructiva y uno obstructiva. En 15 niños se efectuó ad-más la variante F-15 por curva dudosa o eliminación retrasada. El paciente con curva obstructiva presentó un diámetro pélvico de 15 mm en la ECO, estudiándose con urografía intravenosa (UIV) que evidenció una dilatación mayor, grado III, por lo que fue intervenido. El tiempo medio de seguimiento ha sido de 23,5 meses (13 a 53 meses), no apreciando ningún cambio y, por consiguiente, no modificando la actitud tomada. CONCLUSIÓN: Hoy en día las dilataciones pielo-caliciales grado II ecográfico con diámetro pélvico inferior a 15 mm se pueden controlar con ECO sin renograma, ya que no son obstructivas, realizándose éste último si aumenta el grado de dilatación (AU)

[Testicular tumors in childhood. Review of cases in the course of 13 years]. / Tumores testiculares en la infancia. Revisión de 13 años.

Testicular and paratesticular tumors are rare in childhood, representing 1-2 percent of the solid tumors in the pediatric age. In patients under 14 years, the incidence is 0.5-2/100,000. The evolution differs from that of the adult. Since 1981 to 1994 we have treated 14 cases of testicular and paratesticular tumors. Mean age was 2.54 years, the younger patients presenting germinal tumors. The most frequent tumor was the yolk sac tumor (36%), followed by teratoma mature (29%), and Leydig cell tumor, epidermoid cyst, paratesticular fibrous hamartoma, paratesticular neuroblastoma and paratesticular rabdomyosarcoma (7% each). A testicular mass was present in all cases (100%). Testicular ultrasound was used in 100%. In all the patients with malignant tumors a thoraco-abdominal CT scans was done to rule out extension or the tumor, being negative in all cases. Alphafetoprotein were high in all the cases of yolk sac tumor, being within normal range one month after surgery except in one case. In 11 patients an orquiectomy was done through an inguinal approach, and in three cases a simple tumorectomy without orquiectomy. No lymphadenectomy was done. All the malignants neoplasms were stage I tumors, except one yolk sac tumor stage III. Postop chemotherapy was applied in this one and in the embrionary rabdomyosarcoma. There were no recurrences after a follow-up mean time of 3.98.

Diuresis renography in the diagnosis and follow-up of nonobstructive primary megaureter.

Due to the widespread use of obstetrical ultrasonography with concomitant fetal screening, congenital uropathies are usually diagnosed in asymptomatic neonates. The main issue is to distinguish those cases of dilatation which are clearly obstructive and need surgical treatment from those which are within the normal anatomical range. Out of 47 patients with primary megaureter, 23 were nonobstructive and these are the subject of our study. There were 16 males and 7 females. Thirteen were located on the left side, 7 on the right side and 3 were bilateral, adding up to 26 renoureteral units. Prenatal diagnosis was made in 16 cases, the oldest patient diagnosed was 9 years old. All infants were evaluated with ultrasonography, voiding cystourethrography, excretory urography and diuresis renography. The latter has been the most important test inducing us to adopt a conservative attitude. Differential renal function was more than 40% in 24 units and in 2 it was more than 35%. Diuretic renograms were type IIIa (dilated, nonobstructed) in 19 cases and IIIb (dilated, partially obstructed) in 7. There were 2 cases with vesicoureteral reflux in the contralateral system. We performed ultrasonography and diuresis renography during the follow-up. There were 8 cases with type I (normal) renograms and 17 cases with type IIIa. Only one patient developed an obstruction and was operated on. Differential renal function did not deteriorate in any of the cases. Urography was performed in 9 cases during the follow-up. All the patients have remained asymptomatic during the surveillance, except for 2 cases which presented urinary tract infection. BUN, creatinine and other biochemical figures remained within the normal range. The follow-up period of time ranged between 1 and 8 years. We conclude that primary megaureter must be assessed and followed up and that the main test to be used is diuresis renography.