Ureteral meatotomy as an option in the management of primary obstructive megaureter in neonates and infants. / Meatotomía ureteral como opción para gestión del megauréter obstructivo primario en neonatos y lactantes.

Differentiating between the cases of megaureter that require surgery and the ones in whom treatment can be delayed is challenging. A large number of surgical techniques for the treatment of POM been proposed aiming mainly to reduce renal damage by relieving the affected ureter. Resection of the affected ureteral segment followed by vesicoureteral reimplantation either with or without reduction ureteroplasty is the classic treatment, however posing a high rate of complications when performed in patients aged less than one year. Endoscopic techniques have also been described to avoid external diversion. Recently, refluxing ureteral reimplantation has been proposed as a temporary treatment for patients with POM. OBJECTIVE: To describe the ureteral meatotomy technique as an alternative to the refluxing ureteral reimplantation for POM in patients aged less than one year. METHOD: Retrospective study of patients with POM undergoing ureteral meatotomy, aiming to temporarily relieve the ureter. The procedure consists of a 1.5 cm-long cut made with scissors on the upper edge of the ureteral ostium at the 12 o'clock position, until the dilated portion of the ureter was found and abundant urine drainage was observed. The edges of the incision were sutured, joining together the ureteral mucosa and the bladder mucosa. RESULT: From 2011 to 2015, three patients with POM underwent ureteral meatotomy, with four renal units treated altogether. None of the patients presented complications and, as a sign of obstruction relief, all showed reduced dilatation at the ultrasound. No patient had complications. CONCLUSIONS: Ureteral meatotomy is a safe and effective technique in the initial treatment of POM in patients aged less than one year.

Meatotomía ureteral como opción para gestión del megauréter obstructivo primario en neonatos y lactantes / Ureteral meatotomy as option in the management of primary obstructive megaureter in neonates and infants

La diferenciación de los casos de megauréter que requieren cirugía de los que se pueden conducir de forma expectante es un desafío. Numerosas técnicas operatorias para el tratamiento del MOP han sido propuestas, teniendo como principal objetivo la reducción del daño renal desbloqueando el uréter afectado. La resección del segmento comprometido seguido del reimplante vesicoureteral con o sin ureteroplastia reductiva es el tratamiento clásico, pero tiene alta tasa de complicaciones cuando se realiza en niños menores de un año de edad. Las técnicas endoscópicas también han sido descritas para evitar la derivación externa. Recientemente se ha propuesto llevar a cabo el reimplante ureteral refluyente como un tratamiento temporal para pacientes con MOP. OBJETIVO: Describir la técnica de meatotomía ureteral como alternativa al reimplante ureteral refluyente para tratamiento del MOP en niños menores de un año de edad. MÉTODO: Estudio retrospectivo de los pacientes con MOP que se sometieron a meatotomía ureteral, con objetivo de la desobstrucción ureteral temporal. El procedimiento consiste en una sección del ostium ureteral con tijeras en su borde superior a las 12 horas, por una extensión de 1,5 cm hasta alcanzar la parte dilatada del uréter y observar abundante drenaje de orina. Los bordes de la sección son suturados, juntando la mucosa ureteral a la mucosa vesical. RESULTADO: En el período 2011-2015, tres pacientes con MOP fueron sometidos a meatotomía ureteral, por un total de cuatro unidades renales tratadas. Ningún paciente presentó complicaciones y todos tuvieron reducción de la dilatación al ultrasonido, como señal de desobstrucción. Ningún paciente presentó complicaciones. CONCLUSIONES: La meatotomía ureteral es una técnica segura y eficaz para el tratamiento inicial del MOP en niños menores de un año de edad

Differentiating between the cases of megaureter that require surgery and the ones in whom treatment can be delayed is challenging. A large number of surgical techniques for the treatment of POM have been proposed aiming mainly to reduce renal damage by relieving the affected ureter. Resection of the affected ureteral segment followed by vesicoureteral reimplantation either with or without reduction ureteroplasty is the classic treatment, however posing a high rate of complications when performed in patients aged less than one year. Endoscopic techniques have also been described to avoid external diversion. Recently, refluxing ureteral reimplantation has been proposed as a temporary treatment for patients with POM. OBJECTIVE: To describe the ureteral meatotomy technique as an alternative to the refluxing ureteral reimplantation for POM in patients aged less than one year. METHOD: Retrospective study of patients with POM undergoing ureteral meatotomy, aiming to temporarily relieve the ureter. The procedure consists of a 1.5 cm-long cut made with scissors on the upper edge of the ureteral ostium at the 12 o’clock position, until the dilated portion of the ureter was found and abundant urine drainage was observed. The edges of the incision were sutured, joining together the ureteral mucosa and the bladder mucosa. RESULT: From 2011 to 2015, three patients with POM underwent ureteral meatotomy, with four renal units treated altogether. None of the patients presented complications and, as a sign of obstruction relief, all showed reduced dilatation at the ultrasound. No patient had complications. CONCLUSIONS: Ureteral meatotomy is a safe and effective technique in the initial treatment of POM in patients aged less than one year

Urethral duplication--a wide spectrum of anomalies.

OBJECTIVE: Urethral duplications are rare lower urinary tract anomalies, with multiple anatomical variants described. This paper aims to separate this complex anomaly into different diseases, each with distinct clinical forms according to the disturbance during embryogenesis, yet noting a few similarities that may be helpful in their management. The classification system of urethral duplication is also discussed. MATERIAL AND METHODS: Twelve urethral duplication cases over a 14-year period were reviewed. Clinical presentation, the imaging studies used to ascertain anatomical details, type of urethral duplication and surgical correction used in the treatment of patients are presented. RESULTS: Nine patients had urethral duplication in the sagittal plane and three patients in the coronal plane. Of the patients with sagittal urethral duplication, 3 had pre pubic sinus, 3 had epispadiac urethral duplication, 1 had a dorsal urethral duplication deviated from the midline and 2 had hypospadiac urethral duplication. All the patients with coronal urethral duplication had associated bladder duplication. The surgical correction of the patients with sagittal urethral duplication included excision of the pre pubic sinus, excision of the duplicated urethra, and urethroplasty. Excision of the hemibladders' septum and closure of one bladder neck was the treatment for patients with coronal urethral duplication and bladder duplication. CONCLUSION: Urethral duplication is a complex anomaly and the different manifestations probably have different embryological origins. Each group, sagittal or coronal, has a few similarities that may be helpful in their management, although every diagnosed case presents a unique anatomy and surgical treatment must be individualized.

Pelvic fracture urethral distraction defects in children managed by anterior sagittal trans anorectal approach: a facilitating and safe access.

PURPOSE: Trauma injuries of the posterior urethra resulting from pelvic fracture in children tend to be complete ruptures, with upper dislocation of the prostate. This paper aims to show our experience in using an anterior sagittal transanorectal approach (ASTRA) in the treatment of such injuries. MATERIALS AND METHODS: The medical records of 11 patients with pelvic fracture urethral distraction defects who had undergone anastomotic urethroplasty through ASTRA between 1997 and 2009 were reviewed. Ages ranged from 1 year and 6 months to 23 years (mean age 11 years). Of the 11 patients, 8 had previously undergone failed urethroplasties. RESULTS: In 10 patients it was possible to perform tension free urethroplasty. One patient required inferior pubectomy and separation of the corpora cavernosa. Patients' follow-up time varied from 10 months to 10 years and 9 months (mean 41 months). One patient had a urethral fistula and evolved with a urethral diverticulum successfully managed by diverticulectomy. One patient presented a urethral stenosis managed by urethral dilatation. Of the 11 patients, 9 presented functional urethral flow and are continent. Two patients had no urethral flow. One is undergoing bladder catheterization through the Mitrofanoff principle and the other one through the urethra. No patient presented fecal incontinence or rectourethral fistula. CONCLUSION: This access, which is increasingly being used to approach posterior urethral diseases, has proved to be safe and effective in the treatment of pelvic fracture urethral distraction defects.

Early morphological and histochemical alterations in rats subjected to ileocystoplasty.

PURPOSE: To study morphologic and histochemical alterations arising at the ileocystoplasty site. METHODS: Sixteen Wistar female rats were subjected to ileocystoplasty and sacrificed after eight weeks. Material collected was divided into four groups for histological and histochemical studies: Group I (control) - isolated ileum segment removed during ileocystoplasty; Group II - ileoileal anastomosis; Group III - ileovesical anastomosis and Group IV - ileal segment from the neobladder. Histological and histochemical study assessed dysplasia, metaplasia, acute and chronic inflammation, fibrosis, atrophy, hypertrophy, total mucins, sialomucins and sulfomucins. The non-parametric Wilcoxon and Mann-Whitney tests were employed in statistical analysis. RESULTS: None of the groups presented dysplasia. Acute inflammation and atrophy occurred in Groups II, III and IV, not reaching statistical significance. Metaplasia was significant only in Group III (p=0.012). Chronic inflammation, fibrosis and hypertrophy were significant in Groups II, III and IV. There was a significant increase in total mucin content in Group IV (p=0.014) and a reduction in Group III (p=0.016). Increases in sialomucins were observed in samples for Groups III (p=0.003) and IV (p=0.002) along with reduced sulfomucins in samples from Groups III (p=0.013) and IV (p=0.008). CONCLUSION: Ileocystoplasty in female rats caused squamous metaplasia, chronic inflammatory infiltration, fibrosis, hypertrophy, increase in sialomucin content, reduction in sulfomucins, and alterations in total mucin content with statistical significance, as well acute inflammatory infiltration and muscular atrophy with less intensity.

Early morphological and histochemical alterations in rats subjected to ileocystoplasty / Alterações morfológicas e histoquímicas precoces em ratos submetidos à ileocistoplastia

PURPOSE: To study morphologic and histochemical alterations arising at the ileocystoplasty site. METHODS: Sixteen Wistar female rats were subjected to ileocystoplasty and sacrificed after eight weeks. Material collected was divided into four groups for histological and histochemical studies: Group I (control) - isolated ileum segment removed during ileocystoplasty; Group II - ileoileal anastomosis; Group III - ileovesical anastomosis and Group IV - ileal segment from the neobladder. Histological and histochemical study assessed dysplasia, metaplasia, acute and chronic inflammation, fibrosis, atrophy, hypertrophy, total mucins, sialomucins and sulfomucins. The non-parametric Wilcoxon and Mann-Whitney tests were employed in statistical analysis. RESULTS: None of the groups presented dysplasia. Acute inflammation and atrophy occurred in Groups II, III and IV, not reaching statistical significance. Metaplasia was significant only in Group III (p=0.012). Chronic inflammation, fibrosis and hypertrophy were significant in Groups II, III and IV. There was a significant increase in total mucin content in Group IV (p=0.014) and a reduction in Group III (p=0.016). Increases in sialomucins were observed in samples for Groups III (p=0.003) and IV (p=0.002) along with reduced sulfomucins in samples from Groups III (p=0.013) and IV (p=0.008). CONCLUSION: Ileocystoplasty in female rats caused squamous metaplasia, chronic inflammatory infiltration, fibrosis, hypertrophy, increase in sialomucin content, reduction in sulfomucins, and alterations in total mucin content with statistical significance, as well acute inflammatory infiltration and muscular atrophy with less intensity.

OBJETIVO: Estudar alterações morfológicas e histoquímicas nas ileocistoplastias em ratos fêmea. MÉTODOS: 16 ratos fêmea foram submetidos à ileocistoplastia, sacrificadas após oito semanas. O material coletado foi e dividido em quatro grupos para análise morfológica e histoquímica: Grupo I (controle) biópsia intestinal no momento da cirurgia; Grupo II - anastomose íleo-ileal; Grupo III - anastomose íleo-vesical e Grupo IV - segmento intestinal da neobexiga. Os parâmetros avaliados foram: displasia, metaplasia, processo inflamatório agudo e crônico, fibrose, atrofia, hipertrofia, conteúdo total de mucinas, sialomucinas e sulfomucinas. Utilizou-se os testes não-paramétricos de Wilcoxon e Mann-Whitney para estudo estatístico. RESULTADOS: Não houve displasia. Processo inflamatório agudo e atrofia ocorreram nos grupos II, III e IV, sem significância estatística. Metaplasia com significância estatística ocorreu somente no grupo III (p=0.012). Processo inflamatório crônico, fibrose e hipertrofia foram significantes nos grupos II, III e IV. Observou-se aumento significante no conteúdo total de mucinas no grupo IV (p=0.014) e redução no grupo III (p=0.013). Aumento significante de sialomucinas foi observado nos grupos III (p=0.003) e IV (p=0.002) e redução significante das sulfomucinas nos grupos III (p=0.013) e IV (p=0.008). CONCLUSÃO: Nas ileocistoplastias em ratos fêmea observou-se metaplasia escamosa, processo inflamatório crônico, fibrose, hipertrofia, aumento do conteúdo de sialomucinas, redução das sulfomucinas e alterações no conteúdo total de mucinas com significância estatística, bem como atrofia e processo inflamatório agudo em menor intensidade.

Congenital megaprepuce: a new alternative technique for surgical correction.

OBJECTIVE: To present a new alternative technique for surgical treatment of congenital megaprepuce. MATERIALS AND METHODS: From April 2004 to April 2006, five patients aged 2 to 5 years were treated using the new technique. The technique is described and illustrated. It differs from other techniques in that it takes into consideration the constant ballooning of the foreskin, which gives to the external genitalia the aspect of a penoscrotal transposition. Cosmetic and functional success were also assessed by a case review. RESULTS: After a follow-up of 1 to 3 years, all patients have normal voiding and a satisfactory cosmetic aspect. CONCLUSION: This new technique could be a useful alternative in treatment of the congenital megaprepuce.

Congenital megaprepuce: a new alternative technique for surgical correction

OBJECTIVE: To present a new alternative technique for surgical treatment of congenital megaprepuce. MATERIALS AND METHODS: From April 2004 to April 2006, five patients aged 2 to 5 years were treated using the new technique. The technique is described and illustrated. It differs from other techniques in that it takes into consideration the constant ballooning of the foreskin, which gives to the external genitalia the aspect of a penoscrotal transposition. Cosmetic and functional success were also assessed by a case review. RESULTS: After a follow-up of 1 to 3 years, all patients have normal voiding and a satisfactory cosmetic aspect. CONCLUSION: This new technique could be a useful alternative in treatment of the congenital megaprepuce.

Tratamento endoscópico do refluxo vesicoureteral após a cura da instabilidade vesical / Endoscopic treatment of vesico-ureteral reflux following cure of vesical instability

Objetivo: Avaliar a eficácia do uso de "dextranomer hyaluronic acid copopymer (Deflux®)" no tratamento de pacientes com disfunção miccional e refluxo vesicoureteral (RVU) persistente após a cura da disfunção miccional. Pacientes e Métodos: Dos pacientes portadores de disfunção miccional e RVU, 30 foram submetidos ao tratamento do refluxo persistente com Deflux®, após a cura da disfunção miccional. Dos pacientes, 22 eram do sexo feminino e oito do sexo masculino, com idade variando de um ano e dez meses a 16 anos. De um total de 46 unidades ureterovesicais refluxivas, nenhuma apresentava RVU grau I, quatro RVU grau II, 38 apresentavam RVU grau III e quatro apresentavam RVU grau IV. O período de acompanhamento variou de seis meses a cinco anos. Quando o RVU persistiu, apesar do tratamento, uma segunda e, eventualmente, uma terceira injeção foi programada, utilizando a mesma técnica descrita. Resultados: Em todas as quatro unidades ureterais apresentando RVU grau II o refluxo desapareceu após uma simples injeção de Deflux®. Das 38 unidades ureterais apresentando RVU grau III, em 30 o refluxo desapareceu com apenas uma aplicação, em duas unidades após duas aplicações e em uma unidade desapareceu somente após a terceira aplicação. Das quatro unidades que apresentavam refluxo grau IV, somente em uma unidade o RVU desapareceu. Conclusão: O tratamento com Deflux® foi efetivo em mais de 80% dos casos em que existia um RVU grau II ou III, mas foi capaz de tratar o RVU em somente em uma das quatro unidades com RVU grau IV. Uma segunda injeção endoscópica pode eventualmente ser eficaz nos casos de falha inicial do tratamento.

Ectopic opening of the vas deferens into a Müllerian duct cyst.

Two consecutive cases of ectopic opening of the vas deferens into Müllerian duct cysts are presented, with descriptions of the presentation, physical examination, radiographic and ultrasonographic images, surgical findings and treatment undertaken. In both cases, ablation of the cyst and ligature of the vas deferens was the technique employed. Both patients are currently well, with normal urinary flow and no urinary tract infections, 3 years after surgery. Ectopic opening of the vas deferens into Müllerian duct cysts is a rare entity but should always be considered when a child presents with purulent urinary discharge and abdominal tumor. Surgery is the only treatment recommended.

Transposiçäo de pênis e escroto: apresentaçäo de 18 casos e uma nova proposiçäo de técnica cirúrgica / Penis and scrotum transposition: report of 18 cases and proposal of a new surgical technique

As autores apresentam 18 casos de crianças com transposiçäo de pênis e escroto, associada com hipospadia e escroto bífido, dos quais 15 foram operados pela técnica de Glenn, com modificaçöes. Fazem uma revisäo bibliográfica, compilando 59 casos de crianças operadas por diferentes técnicas cirúrgicas, dentre elas a descrita por Glenn. No entanto, foram encontradas duas casuísticas semelhantes ao presente trabalho

Infecçäo urinária na criança: aspectos urológicos / Primary tract infection in children

O trabalho analisa as implicaçöes urológicas da infecçäo urinária na criança, estudando, em particular, a hidronefrose e obstruçäo da junçäo uretro-piélica; o refluxo víseico-reteral; e as válvulas de uretra posterior. Em cada um desses capítulos säo revistos a importância do problema, o quadro clínico, exames complementares indicados para seu diagnóstico e o tratamento, especialmente quanto aos procedimentos cirúrgicos, seguimento pós-operatório e prevençäo das possíveis complicaçöes

Transposiçäo de pênis e escroto: apresentaçäo de 16 casos de uma nova proposiçäo cirúrgica / Penis and scrotum transposition: report of 16 cases and a new surgical proposition

Apresentam-se 16 casos de crianças com transposiçäo de pênis e escroto, com hipospádia e bifidez escrotal, dos quais 14 foram operados pela técnica de Glenn com modificaçöes. Faz-se uma revisäo bibliográfica, compilando 39 casos de crianças operadas por diferentes técnicas cirúrgicas, dentre as quais a descrita por Glenn. No entanto, näo foi encontrada casuística semelhante à do presente trabalho