Válvulas ureterales en el niño. Tratamiento minimamente invasivo mediante laser holmium / Conservative treatmet of ureteral valve with holmium laser in a child

OBJETIVOS: Presentar el manejo terapéutico mínimamente invasivo de la obstrucción unilateral del tracto urinario superior producida por una válvula ureteral.MÉTODO: Descripción del caso clínico, la técnica endourológica utilizada y de los resultados a medio plazo, con apoyo de la literatura publicada al respecto.RESULTADOS: Paciente de 12 años con clínica de dolor en flanco derecho. En la ecografía presentó ureterohidronefrosis derecha con parénquima conservado. La Uro-resonancia magnética reveló la presencia de un defecto de repleción en el tercio medio del uréter derecho y descartó una compresión extrínseca. En la ureterorrenoscopia se observó la válvula ureteral que fue resecada mediante laser holmium. La derivación ureteral se mantuvo 3 semanas. Tras 12 meses del tratamiento la paciente presentó ausencia de clínica y de ureterohidronefrosis derecha en ecografías de control.CONCLUSIONES: El tratamiento endourológico mediante resección de la válvula ureteral obstructiva usando el laser Holmium Dormier es un método poco invasivo seguro y eficaz a corto-medio plazo(AU)

OBJECTIVES: To present the minimally invasive management of an annular ureteric valve causing upper urinary tract obstruction.METHODS: A case report description: endourological technique and medium-term results with review of the published reports.RESULTS: A 12 year old patient with right flank pain was attended. Ultrasound showed right ureterohydronephrosis with conserved parenchyma. Uro-MRI (axial plane) showed dilation down to the middle of the right ureter with a filling defect, without extrinsic compression. Ureterorenoscopy showed a ureteral valve that was resected by holmium laser. Ureteral stent was maintained for 3 weeks. Twelve months after treatment patient has no symptoms and the following ultrasounds did not reveal right ureterohydronephrosis.CONCLUSIONS: Obstructive ureteral valve resection by endourological treatment using a Dornier holmium laser is a safe and effective minimally invasive method according to short and medium term results(AU)

Megalouretra congénita asociada a reflujo bilateral masivo / Congenital megalourethra associated with massive bilateral reflux

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Pediatric renal adenocarcinoma: a review of our series.

OBJECTIVES: To report our experience with pediatric renal adenocarcinoma. METHODS: We conducted a retrospective review of renal adenocarcinoma cases from 1971 to 2006. RESULTS: We treated 154 patients with renal tumor, 4 (2.6%) of whom had adenocarcinoma. The mean age of presentation was 8.5 years (range, 2-15 years). Three patients were female and 1 was male. The most common histologic subtype was clear cell carcinoma. Three patients were diagnosed as stage IIIB and one as stage II, according to Robson's classification. All patients were treated with radical nephroureterectomy. One patient died of disease and the other 3 are currently disease-free. CONCLUSIONS: Adenocarcinoma is an uncommon histopathologic type of pediatric renal tumor. In patients with hematuria and abdominal or flank pain, we should consider this tumor as a possible diagnosis.

[Endoscopic treatment of vesicoureteral reflux in pediatric patients with the diagnosis of neurogenic bladder. Results and long-term outcome]. / Tratamiento endoscópico del reflujo vésicoureteral en pacientes pediátricos diagnosticados de vejiga neurógena. Resultados y evolución a largo plazo.

OBJECTIVES: To know the results, complications and outcomes of eight patients with the diagnosis of neurogenic bladder (NB) who underwent vesicoureteral reflux surgery by subureteral injection of inert substances, trying to precise its indication in the therapeutic scheme for neurogenic bladder dysfunction. METHODS: Retrospective review of the results and complications recorded during follow-up in eight pediatric patients with NB secondary to various pathologies and the diagnosis of VUR treated by subureteral injection of Teflon paste (1 case), polydimethylsiloxane (6) and dextranomer/hyaluronic acid copolymer (1). RESULTS: In 8 (72.7%) of the 11 ureters treated VUR was cured after first injection. VUR stopped after second endoscopic treatment in 2 of the 3 ureters with persistent VUR. The efficacy of endoscopic treatment after second injection achieved 90.9%. In 2 unilateral cases we observed contralateral VUR, which cured in one case after endoscopic treatment and the other one followed a conservative scheme. Over the follow-up period (Mean FU time 51.8 +/- 28.5 months) 4 cases presented complications. VUR recurred in two: in one contralateral VUR was detected 19 months after first treatment, the other one presented bilateral ureterohydronephrosis with recurrent urinary tract infections and required augmentation cystoplasty. CONCLUSIONS: Endoscopic treatment is an effective option when choosing surgical treatment for VUR in a patient with neurogenic bladder. It is necessary to follow the long-term outcome of patients after surgery, mainly those with abnormal bladder capacity and compliance and active or dyssynergic urethra due to the possibility of recurrence of the VUR.

Tratamiento endoscópico del reflujo vésicoureteral en pacientes pediátricos diagnosticados de vejiga neurógena. Resultados y evolución a largo plazo / Endoscopic treatment of vesicoureteral reflux in pediatric patients with the diagnosis of neurogenic bladder. Results and long-term outcome

Objetivo: Conocer los resultados, complicaciones y la evolución de ocho pacientes diagnosticados de Vejiga neurógena (VN), intervenidos de Reflujo vesicoureteral (RVU) mediante la inyección subureteral de sustancias inertes, intentando precisar su indicación en el esquema terapéutico de la alteración vesical neurógena. Métodos: Revisión retrospectiva de los resultados obtenidos y de las complicaciones evidenciadas durante los controles evolutivos efectuados a ocho pacientes en edad pediátrica con VN secundaria a diferentes patologías, diagnosticados de RVU, tratado mediante inyección subureteral de pasta de teflón (1 caso), polidimetilsiloxano (6) y copolímero de dextranómero y ácido hialurónico (1). Resultados: De los 11 uréteres tratados en 8 (72.7%) el RVU curó después de la primera inyección. De los 3 uréteres con persistencia del RVU, en dos cesó después del segundo tratamiento endoscópico (TE). La eficacia del TE después de la segunda inyección alcanzó el 90.9%. En dos casos unilaterales evidenciamos RVU contralateral que curó mediante TE en uno siguiendo pauta conservadora el segundo. Durante el periodo de seguimiento (tiempo medio: 51.8 +/- 28.5 meses) presentaron complicaciones 4 casos. Reapareció el RVU en dos, observamos RVU contralateral en uno a los 19 meses del primer tratamiento y en otro evidenciamos ureterohidronefrosis bilateral con infecciones urinarias recurrentes que precisó de cistoplastia de aumento. Conclusiones: El TE es una opción eficaz cuando se decide el tratamiento quirúrgico del RVU en un paciente con vejiga neurógena. Es necesario seguir la evolución a largo plazo de los pacientes intervenidos, sobre todo aquellos con capacidad y acomodación vesical alterada y uretra activa o disinérgica, ante la posibilidad de aparición del RVU ya curado (AU)

Objectives: To know the results, complications and outcomes of eight patients with the diagnosis of neurogenic bladder (NB) who underwent vesicoureteral reflux surgery by subureteral injection of inert substances, trying to precise its indication in the therapeutic scheme for neurogenic bladder dysfunction. Methods: Retrospective review of the results and complications recorded during follow-up in eight pediatric patients with NB secondary to various pathologies and the diagnosis of VUR treated by subureteral injection of Teflon paste (1 case), polydimethylsiloxane (6) and dextranomer/hyaluronic acid copolymer (1). Results: In 8 (72.7%) of the 11 ureters treated VUR was cured after first injection. VUR stopped after second endoscopic treatment in 2 of the 3 ureters with persistent VUR. The efficacy of endoscopic treatment after second injection achieved 90.9%. In 2 unilateral cases we observed contralateral VUR, which cured in one case after endoscopic treatment and the other one followed a conservative scheme. Over the follow-up period (Mean FU time 51.8+/- 28.5 months) 4 cases presented complications. VUR recurred in two: in one contralateral VUR was detected 19 months after first treatment, the other one presented bilateral ureterohydronephrosis with recurrent urinary tract infections and required augmentation cystoplasty. Conclusions: Endoscopic treatment is an effective option when choosing surgical treatment for VUR in a patient with neurogenic bladder. It is necessary to follow the long-term outcome of patients after surgery, mainly those with abnormal bladder capacity and compliance and active or dyssynergic urethra due to the possibility of recurrence of the VUR (AU)

Renal transplantation in children with posterior urethral valves.

The objective of this study was to analyze whether renal transplantation (RT) in children with posterior urethral valves (PUV) constitutes a special group with respect to groups with different etiologies of end-stage renal disease (ESRD). Between 1979 and 2004, 22 RT were performed in 19 children with PUV. The median age at RT was 10 years (range: 1.3-17). Immunosuppression was provided by triple therapy and polyclonal/monoclonal antibodies. This group was compared with the two control groups: (1) glomerulopathy (n=62) and (2) pyelonephritis/dysplasia (n=42) without lower urinary tract disease, transplanted in the same period. Ten graft losses occurred in 22 transplants: thrombosis (2), acute rejection (3), chronic graft nephropathy (2), and death of patients (3) with a functioning graft in the 1st postoperative month. We did not find significant differences versus the control group in renal function or probability of graft or patient survival at 1, 5, and 10 years. We observed a greater risk of urological complication in patients with PUV. RT with PUV constitutes a special group due to the compulsory young age and the need for careful and complex medicosurgical management; nevertheless, the results achieved were similar to those obtained in our general RT population.

Influence of the type of operations on the development of latex sensitization in children with myelomeningocele.

BACKGROUND: A genetic tendency to develop latex IgE responses in children with spina bifida has been suggested, but their degree of exposure to latex as well as the route and chronology for sensitization can be different from those of other children with multiple surgeries. The aim was to study the influence of the type of operation on the development of latex sensitization in children with myelomeningocele. METHODS: In 90 children with myelomeningocele operated with latex, data were collected about age, sex, family, and personal history of allergy, serum total IgE, presence of a ventricular-peritoneal (v-p) shunt, and number and duration of operations, classified as urological, orthopedic, on the v-p shunt, other neurosurgical, and others. A multivariate logistic regression analysis was performed, using the presence of latex sensitization as dependent variable. RESULTS: Serum total IgE, the number of urological and of orthopedic operations were synergistic variables to predict latex sensitization, together with the presence of a v-p shunt, but not the number of operations performed on this device. This seems to play an adjuvant role in the process of sensitization. CONCLUSIONS: Not only the number, but also the type of operations, namely, of urological and orthopedic nature, is important in the development of latex sensitization in children with myelomeningocele.

The use of neural networks for predicting the result of endoscopic treatment for vesico-ureteric reflux.

OBJECTIVE: To create an artificial neural network (ANN) to aid in predicting the results of endoscopic treatment for vesico-ureteric reflux (VUR). MATERIALS AND METHODS: During 1999-2001 we used endoscopic treatment in 261 ureteric units with VUR of all grades and causes. An ANN based on multilayer perceptron architecture was created using an 11 x 6 x 1 structure, taking the following as variables: the cause and grade of VUR, the patient's age and sex, the type of implanted substance and its volume, the number of treatments, the affected ureter, the endoscopic findings, and the type of cystography used. In all, 174 cases were used as training samples for the ANN and 87 to validate it. We calculated the sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and the success rate (%) of the system. RESULTS: In the training group the ANN gave a sensitivity of 86.4%, a specificity of 89.5%, a PPV of 76% and NPV of 94%, with a success rate of 88.6%. In the same training group logistic regression (LR) gave respective values of 68.2%, 58.8%, 39%, 82.7% and 61.4%. In the validation group the respective values for the ANN were 71.4%, 81.6%, 58.8%, 88.6% and 78.9%, and in the same validation group the LR gave 64.4%, 50%, 32.1%, 79.2% and 53.9%. The Wilcoxon test confirmed the independence of both methods (P < 0.001). CONCLUSION: The ANN is an effective tool for assisting the urologist in indicating and applying endoscopic treatments for VUR.

[Encrusted pyelitis in a transplanted kidney]. / Pielitis incrustante en riñón trasplantado.

OBJECTIVES: To emphasize the importance of early diagnosis of encrusted pyelitis in kidney transplant patients. METHODS: We report one case of encrusted pyelitis in a 10-year-old girl with a kidney graft who was treated by means of nephrostomy tube irrigation with an acidifier liquid substance. RESULTS: After 16 days of treatment there was a significant decrease of the size of the calcified pyelic plaque, keeping a good renal function afterwards. CONCLUSIONS: This disease should be thought of in every case of kidney transplant patient with negative urine cultures and alkaline pH, and the microbiologist should be alerted of the possibility of urinary tract infection by Corynebacterium.

Pielitis incrustante en riñón trasplantado / Encrusted pyelitis in a transplanted kidney

OBJETIVO: Destacar la importancia del diagnóstico precoz de la pielitis incrustante (PI) en pacientes trasplantados renales. MÉTODO: Presentamos un caso de PI en una niña de 10 años portadora de injerto renal que tratamos mediante irrigación por nefrostomía de una substancia líquida acidificante. RESULTADOS: Tras 16 días de tratamiento se produjo una disminución del tamaño de la placa piélica calcificada, manteniéndose una buena función renal en la evolución posterior. CONCLUSION: En todos los pacientes trasplantados renales con urinocultivos negativos y pH alcalino debemos pensar en esta patología y comunicar al microbiólogo la posibilidad de infección urinaria por Corynebacteriun. (AU)

[Urachal diverticuli. Diagnosis and treatment]. / Divertículos de uraco. Diagnóstico y tratamiento.

OBJECTIVE: To determine the utility of different diagnostic imaging techniques in diverticulum of the urachus and discuss the approach in the incidentally discovered cases such as those detected due to infectious complications. METHODS/RESULTS: We reviewed the literature, with special reference to the diagnostic and therapeutic aspects of diverticula of the urachus. A case that presented with urinary infection and omphalitis, with the characteristic radiological findings, that resolved after surgical treatment and previous antibiotic therapy, is also described. CONCLUSIONS: Ultrasound is useful in the initial evaluation of patients with signs of periumbilical inflammation. If a urachal diverticulum is diagnosed, retrograde cystourethrography should be performed to rule out associated genitourinary pathology or lower urinary tract obstruction. In cases discovered incidentally, we underscore the importance of elective surgery to excise the diverticulum since it could progress to malignancy. In cases with infectious complications, bladder catheterization and antibiotic treatment before performing subsequent elective surgery offer advantages over primary excision. For young patients, we advocate performing the Pfannenstiel incision. This approach offers excellent visualization and exposure of the entire urachus with a minimum surgical scar.

Efficacy of latex avoidance for primary prevention of latex sensitization in children with spina bifida.

Over 6 years, the prevalence of latex sensitization fell from 4/15 (26.7%) to 1/22 (4.5%) in children with spina bifida treated in a latex-free environment from birth compared with historic controls. These precautions appear to be efficacious for the primary prevention of latex sensitization.

Divertículos de uraco. Diagnóstico y tratamiento / Diverticulum of the urachus: Diagnosis and treatment

OBJETIVO: Establecer la utilidad de las distintas exploraciones radiológicas en el diagnóstico de los divertículos de uraco y discutir la mejor actitud terapéutica tanto en los casos hallados incidentalmente como en aquellos diagnosticados a partir de una complicación infecciosa. MÉTODOS Y RESULTADO: Realizamos una revisión bibliográfica en la que se evalúan las particularidades del manejo diagnóstico-terapéutico de los divertículos de uraco. Presentamos además un caso que debutó con infección urinaria y onfalitis, con hallazgos radiológicos característicos, y resuelto quirúrgicamente después de un período de enfriamiento con antibióticos. CONCLUSIONES: Establecemos la utilidad de la ecografía como primera exploración a realizar ante un paciente con signos inflamatorios periumbilicales. Si se diagnostica un divertículo de uraco, debe practicarse una cistouretrografía retrógrada para descartar patología genito-urinaria asociada u obstrucción del tracto urinario inferior. En los casos hallados incidentalmente, subrayamos la importancia de plantear cirugía programada para su extirpación, dadas las posibilidades de malignización tardía. Cuando se presentan con una complicación infecciosa insistimos en las ventajas del cateterismo vesical y tratamiento antibiótico seguido de excisión diferida, frente a la excisión primaria. En pacientes de corta edad, proponemos la incisión de Pfannenstiel como una vía con buena exposición de todo el uraco y una cicatriz poco visible (AU)

Nefronía lobar aguda. Presentación de un caso en la edad pediátrica / Lobar nephronia in a child : A case report

OBJETIVOS: Aportación de un caso de nefronía lobar aguda en la infancia. MÉTODO: Presentamos un caso de nefronía lobar aguda en un niño de 10 años. Se comentan los aspectos clínicos, diagnósticos y terapéuticos. RESULTADOS: La nefronía lobar aguda o nefritis bacteriana aguda focal es una forma poco frecuente de pielonefritis que puede afectar tanto a adultos como a pacientes en edad pediátrica. Son escasos los casos publicados durante la infancia. Es necesario el uso de técnicas de imagen no sólo para su diagnóstico sino para diferenciarla de otras patologías como los abscesos y otras masas renales de distinto tratamiento. CONCLUSIONES: Destacamos la ecografía como la técnica radiológica de elección en el diagnóstico y en el control evolutivo de la misma (AU)

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