Displasia renal multiquística: evaluación de la necesidad de la gammagrafía renal y seguridad del tratamiento conservador / Multicystic dysplastic kidney: assessment of the need for renal scintigraphy and the safety of conservative treatment

Objetivos: Evaluar la necesidad de la realización de la gammagrafía renal en el diagnóstico de la displasia renal multiquística (DRMQ), así como la seguridad de su tratamiento conservador. Material y métodos: Estudio retrospectivo de los pacientes con DRMQ unilateral en nuestro centro desde enero de 2005 hasta agosto de 2015. Calculamos el valor predictivo positivo (VPP) de la ecografía tomando la gammagrafía renal y la anatomía patológica como gold standard. Realizamos una curva de supervivencia según el método de Kaplan-Meyer para evaluar la probabilidad de resolución espontánea del RM anualmente. Resultados: Se han identificado 56 pacientes, 48 (85,7%) con diagnóstico prenatal, 38 (67,9%) fueron varones y en 33 (58,9%) el lado afecto fue el izquierdo. En 22 (39,29%) observamos anomalías urológicas asociadas, el reflujo vesicoureteral la más frecuente (8 [14,29%]). Siete pacientes (12,5%) han desarrollado insuficiencia renal, y 49 pacientes (87,5%) desarrollaron hipertrofia renal contralateral compensatoria. De los 33 pacientes que se intervinieron el resultado de anatomía patológica confirmó el diagnóstico de DRMQ en 32. En comparación con la gammagrafía el VPP de la ecografía fue del 100% y del 97% al compararla con la anatomía patológica. La tasa de involución espontánea fue del 5,4% a los 3 meses de vida, del 11,3% a los 2 años y del 38,4% a los 5 años. Conclusiones: En nuestra experiencia el tratamiento conservador de la DRMQ, hasta al menos los 5 años de edad, es seguro. Nuestros datos sugieren que la realización de la gammagrafía no es precisa en estos pacientes, lo que supone una menor exposición a la radiación, así como un ahorro económico

Objectives: To assess the need for implementing renal scintigraphy in the diagnosis of the multicystic dysplastic kidney (MCDK) and the safety of its conservative treatment. Material and methods: A retrospective study of patients with unilateral MCDK was conducted at our centre from January 2005 to August 2015. We calculated the positive predictive value (PPV) of ultrasonography, taking renal scintigraphy and pathology as the gold standard. We calculated a survival curve according to the Kaplan-Meier method to assess the annual probability of spontaneous resolution of the multicystic kidney. Results: Fifty-six patients were identified, 48 (85.7%) of whom had a prenatal diagnosis. Thirty eight (67.9%) of the patients were males, and the left side was affected in 33 (58.9%) of the patients. We observed associated urological abnormalities in 22 (39.29%) patients, with vesicoureteral reflux the most common (8, 14.29%). Seven patients (12.5%) developed renal failure. Forty-nine (87.5%) patients developed compensatory contralateral renal hypertrophy. Of the 33 patients who underwent surgery, the pathology results confirmed the MCDK diagnosis in 32. Compared with scintigraphy and pathology, the PPV of ultrasonography was 100% and 97%, respectively. The rate of spontaneous involution was 5.4% at 3 months of life, 11.3% at 2 years and 38.4% at 5 years. Conclusions: In our experience, the conservative treatment of MCDK, until at least 5 years of age, is safe. Our data suggest that performing scintigraphy is not required for these patients, which means lower radiation exposure, as well as financial savings

Multicystic dysplastic kidney: Assessment of the need for renal scintigraphy and the safety of conservative treatment. / Displasia renal multiquística: evaluación de la necesidad de la gammagrafía renal y seguridad del tratamiento conservador.

OBJECTIVES: To assess the need for implementing renal scintigraphy in the diagnosis of the multicystic dysplastic kidney (MCDK) and the safety of its conservative treatment. MATERIAL AND METHODS: A retrospective study of patients with unilateral MCDK was conducted at our centre from January 2005 to August 2015. We calculated the positive predictive value (PPV) of ultrasonography, taking renal scintigraphy and pathology as the gold standard. We calculated a survival curve according to the Kaplan-Meier method to assess the annual probability of spontaneous resolution of the multicystic kidney. RESULTS: Fifty-six patients were identified, 48 (85.7%) of whom had a prenatal diagnosis. Thirty eight (67.9%) of the patients were males, and the left side was affected in 33 (58.9%) of the patients. We observed associated urological abnormalities in 22 (39.29%) patients, with vesicoureteral reflux the most common (8, 14.29%). Seven patients (12.5%) developed renal failure. Forty-nine (87.5%) patients developed compensatory contralateral renal hypertrophy. Of the 33 patients who underwent surgery, the pathology results confirmed the MCDK diagnosis in 32. Compared with scintigraphy and pathology, the PPV of ultrasonography was 100% and 97%, respectively. The rate of spontaneous involution was 5.4% at 3 months of life, 11.3% at 2 years and 38.4% at 5 years. CONCLUSIONS: In our experience, the conservative treatment of MCDK, until at least 5 years of age, is safe. Our data suggest that performing scintigraphy is not required for these patients, which means lower radiation exposure, as well as financial savings.

Urinoma secondary to ureteropelvic junction obstruction in the neonate. Presentation of a case and bibliographic review.

OBJECTIVE: To analyze the management of prenatal urinoma and ureteropelvic junction obstruction (UPJO) postnatally by a case report and literature review. METHODS: We report a case of an UPJO and urinoma in a newborn. After birth, renal function was absent, and nephrectomy was performed. The literature from 1985 to date has been reviewed. DISCUSSION: By the analysis of the literature, we can observe mainly, that prenatally diagnosed urinoma and UPJO are managed conservatively. After birth, different attitudes have been carried out, independently of residual renal function, such as radical or reconstructive surgery, or conservative treatment. CONCLUSION: Intrauterine management is not indicated. Urinary diversion is indicated in symptomatic cases secondary to renal trauma or endoscopic procedure. In non-functional kidney, nephrectomy is indicated.

Urinoma secundario a estenosis de la unión pieloureteral en el neonato. Presentación de un caso y revisión de la literatura / Urinoma secondary to ureteropelvic junction obstruction in the neonate. Presentation of a case and bibliographic review

OBJETIVO: Analizar el manejo del urinoma prenatal y de la estenosis de la unión pieloureteral postnatalmente mediante el estudio de un caso y revisión bibliográfica. MÉTODOS: Se presenta el caso de neonato con EUPU y urinoma. Se comprueba función renal anulada, realizándose nefrectomía. Se ha revisado la literatura desde 1985 hasta la actualidad. DISCUSIÓN: Analizando la literatura, se observa mayoritariamente que el tratamiento de la EUPU y urinoma prenatales es conservador. Tras el nacimiento existen diversas actitudes, independientemente de la función renal remanente, como son la cirugía radical, la reconstructiva o el tratamiento conservador. CONCLUSIONES: La manipulación intraútero no está indicada sistemáticamente. La derivación urinaria sólo en casos sintomáticos y los secundarios a traumatismo o manipulación endoscópica. En riñones anulados estaría indicada la nefrectomía (AU)

OBJECTIVE: To analyze the management of prenatal urinoma and Ureteropelvic Junction Obstruction (UPJO) postnatally by a case report and literature review. METHODS: We report a case of an UPJO and urinoma in a newborn. After birth, renal function was absent, and nephrectomy was performed. The literature from 1985 to date has been reviewed. DISCUSSION: By the analysis of the literature, we can observe mainly, that prenatally diagnosed urinoma and UPJO are managed conservatively. After birth, different attitudes have been carried out, independently of residual renal function, such as radical or reconstructive surgery, or conservative treatment. CONCLUSION: Intrauterine management is not indicated. Urinary diversion is indicated in symptomatic cases secondary to renal trauma or endoscopic procedure. In non-functional kidney, nephrectomy is indicated (AU)

Poliposis ureteral en la adolescencia / Urethral polyposis in adolescence

Los pólipos de aparato urinario son poco frecuentes, siendo su localización más habitual el uréter proximal. Estas lesiones benignas y con escasa tendencia a la recidiva tienen distintas formas de presentación que, en muchos casos, deben ser diferenciadas de formas malignas. Mientras que la sospecha diagnóstica de esta entidad suele ser clínica por síntomas derivados de la obstrucción urinaria, las pruebas radiológicas desempeñan un papel fundamental en el diagnóstico final. El tratamiento es lo menos invasivo posible, con resección endoscópicao cirugía mínimamente invasiva (AU)

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 orminimally invasive surgery (AU)

[Urethral polyposis in adolescence]. / Poliposis ureteral en la adolescencia.

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.

[Congenital fibroepithelial polyps of the urethra]. / Pólipos fibroepiteliales congénitos de uretra.

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.

Pólipos fibroepiteliales congénitos de uretra / Congenital fibroepithelial polyps of the urethra

Los pólipos fibroepiteliales de uretra comprenden una patología infrecuente, suelen ser diagnosticados en edad pediátrica por hematuria o síndrome obstructivo bajo y requieren tratamiento quirúrgico para su resolución. Presentamos tres casos clínicos, dos varones de seis y nueve años que fueron diagnosticados y tratados de esta patología tras presentar un cuadro de hematuria franca y dificultad miccional, y una niña de dos años que debutó con clínica de prolapso de masa polipoide por uretra (AU)

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 (AU)

[Hypospadias repair with Snodgrass' technique]. / Reparación de hipospadias mediante la Técnica de Snodgrass.

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%.

Reparación de hipospadias mediante la Técnica de Snodgrass / Hypospadias repair with Snodgrass´Technique

Estudio retrospectivo de 124 pacientes (edad media: 3,8 años) con hipospadias peneano medio: 48,3% (60 niños), peneano distal: 45,9% (57) y coronal 5,6% (7), de los cuales el 25,8% (16) presentaban incurvación ventral y el 4,8% (6) procedían del fracaso de otra técnica. Todos ellos intervenidos según técnica de Snodgrass, retirando la sonda entre el 6 y 7º día en la mayoría. La tasa global de complicaciones fue del 12%: 9 fístulas (7,2%) y 6 estenosis de meato (4,8%). El resultado estético fue satisfactorio en todos los casos, quedando incluso el glande cubierto por prepucio el 57,3%

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%

[Assesmment urethrorrhagia in childhood]. / Valoración de la uretrorragia en el niño.

OBJECTIVE: [corrected] To review urethrorrhagia cases, the need of complementary test, its management and natural history. MATERIAL AND METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.

[Parameatal urethral cysts. 3 new paediatric cases and literature review]. / Quistes uretrales parameatales. 3 nuevos casos pediátricos y revisión de la literatura.

We present 3 new cases of urethral parameatal cysts in paediatric age. Literature is reviewed and histological data and ambulatory management are discussed.

Valoración de la uretrorragia en el niño / Assessmment urethrorrhagia in childhood

Objetivo: Revisar los casos de uretrorragia, la necesidad de exploraciones complementarias, su manejo e historia natural. Material y Métodos: Analizamos retrospectivamente 12 pacientes que presentaron una uretrorragia, diagnosticados de forma consecutiva en nuestro centro. Se evaluaron parámetros como la edad, tiempo de evolución y hábito miccional. De igual modo, describimos las técnicas diagnósticas utilizadas, el manejo terapéutico y la evolución del paciente. Resultados: Todos los casos corresponden a varones con edad media de 8,7 años (18 meses y 14 años). Los episodios de uretrorragia aparecen en el 100% de los pacientes, mientras que fueron diarios en el 58,4%. El 33% (4/12) se acompañan además de otra sintomatología miccional. El 75% (9/12) presentaban un hábito miccional perezoso. Entre los antecedentes urológicos destacan: 1 paciente circuncidado hacía 3 años, otro al que se le practicó una meatotomía por estenosis del meato 2 años antes y por último, uno al que se le realizó una electrocoagulación de un pólipo uretral hacía un mes. El 83,4% (10/12) de los urinocultivos realizados fueron negativos. Se practicó uretrocistoscopia en 9 pacientes, detectando en 4 una hipertrofia del verum, en 3 cambios inflamatorios adyacentes a la uretra membranosa, en 1 paciente esfacelos en uretra bulbar y en el último no se objetivaron hallazgos patológicos. De los 8 pacientes que presentaban un hábito miccional perezoso, el 75% (6/8) se resolvieron espontáneamente después de corregir el hábito miccional tras una media de 9 meses. Sólo 2 precisaron tratamiento quirúrgico mediante resección endoscópica transuretral. En los otros 2 pacientes la sintomatología desapareció espontáneamente en el transcurso del seguimiento de los mismos. Conclusiones: La uretrorragia en el niño es un proceso benigno en la gran mayoría de los casos, que se resuelve de forma espontánea prácticamente siempre durante los 2 primeros años de seguimiento. Los estudios radiológicos y las exploraciones endoscópicas resultan innecesarios en el manejo inicial de estos pacientes quedando relegadas a cuadros persistentes en el tiempo

Objetive. To review urethrorrhagia cases, the need of complementary test, its management and natural history. Material and method. 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. Results. 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. Conclusions. 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

Quistes uretrales parameatales. 3 nuevos casos pediátricos y revisión de la literatura / Parameatal urethral cysts. 3 new paediatric cases and literature review

Presentamos 3 nuevos casos de quistes uretrales parameatales en edad pediátrica. Se revisa la literatura y comentamos los hallazgos histológicos y el manejo ambulatorio de estos pacientes

We present 3 new cases of urethral parameatal cysts in paediatric age. Literature is reviewed and histological data and ambulatory management are discussed

Quiste de uraco infectado en edad infantil / Infected urachal cyst during childhood

Los quistes de uraco son anomalías congénitas detectadas con mayor frecuencia en la infancia. Suelen manifestarse cuando se infectan, simulando diversas patologías agudas intraabdominales o pélvicas. Presentamos un caso en una niña de 7 años diagnosticada de quiste de uraco infectado. Analizamos el origen embriológico de esta patología, sus formas de presentación clínica y sus aspectos diagnóstico-terapéuticos

Urachal cysts are congenital anomalies detected predominantly during the childhood. They are often diagnosed when an infection occur mimicking a variety of acute intra-abdominal or pelvic processes. We present a case in a 7-year-old female infant, diagnosed of infected urachal cyst. The embryologic origin of this anomaly, clinical features, diagnosis and treatment are discussed

Megaprepucio congénito: diagnóstico y manejo terapéutico / congenital megaprepuce: diagnosis and terapeutic management

Objetivo: Analizar la presentación clínica, diagnóstico y manejo terapéutico del megaprepucio congénito (MC). Material y métodos: Estudio retrospectivo de los 4 casos de MC diagnosticados y tratados en nuestro Servicio desde octubre 1997 hasta abril de 2005, describiendo el diagnóstico y la técnica quirúrgica empleada en todos ellos. Conclusiones: El MC es una condición infrecuente, que puede confundirse con otras patologías, que es necesario reconocer y tratar correctamente por parte del Urólogo

Objetive: To analize the clinical presentation, diagnosis and surgical management of congenital megaprepuce (CM). Material and methods: We have made a retrospective study of four cases of CM diagnosed and treated in our centre between october 1997 and april 2005. We studied the diagnosis and surgical treatment. Conclusions: CM is an infrecuent condition that can be confused with others pathologies. It´s necessary to diagnose and treat it correctly

[Infected urachal cyst during childhood]. / Quiste de uraco infectado en edad infantil.

Urachal cysts are congenital anomalies detected predominantly during the childhood. They are often diagnosed when an infection occur mimicking a variety of acute intra-abdominal or pelvic processes. We present a case in a 7-year-old female infant, diagnosed of infected urachal cyst. The embryologic origin of this anomaly, clinical features, diagnosis and treatment are discussed.

[Congenital megaprepuce: diagnosis and terapeutic management]. / Megaprepucio congénito: diagnóstico y manejo terapéutico.

OBJECTIVE: [corrected] To analize the clinical presentation, diagnosis and surgical management of congenital megaprepuce (CM). MATERIAL AND METHODS: We have made a retrospective study of four cases of CM diagnosed and treated in our centre between october 1997 and april 2005. We studied the diagnosis and surgical treatment. CONCLUSIONS: CM is an infrecuent condition that can be confused with others pathologies. It's necessary to diagnose and treat it correctly.

[Hemorrhagic infarction of the testicle in the newborn infant. A case presentation]. / Infarto hemorrágico testicular en neonato: presentación de un caso.

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.

[Berdon syndrome (megacystis, microcolon, intestinal hypoperistalsis). Report of our cases]. / Síndrome de Berdon (megavejiga, microcolon, hipoperistalsis). Presentación de nuestros casos.

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.