Octreotide and enterocutaneous fistula closure in neonates and children.

UNLABELLED: Enterocutaneous fistula and its conservative management still pose a challenge for the surgeon. The use of octreotide and somatostatin in neonates and children as adjunctive therapy in the conservative management of this condition, leads to major controversy regarding its efficacy. Therefore, we conducted an extensive literature review of published articles regarding the use of somatostatin and its analogues in the treatment of enterocutaneous fistula in neonates and children. Our review is then presented together with a case vignette and discusses the different practical aspects of the treatment with these drugs. CONCLUSION: The major diversity in treatment regimens among published studies makes outcomes difficult to compare. However, given the results of the different cases reported in the literature and of our own experience, we suggest a possible beneficial effect of octreotide and somatostatin on closure of enterocutaneous fistula in these patients.

[Severe bilateral vesicoureteral reflux and nephropathy in male newborns: valve-like syndrome or uncoordinated voiding in the male fetus]. / Reflujo vesicoureteral bilateral grave y nefropatía renal en pacientes varones recién nacidos: síndrome de válvulas-like o Micción no coordinada en el feto varón.

OBJECTIVES: Various papers differentiating neonatal vesicoureteral reflux (VUR) with severe renal damage from other predominant group of newborns with neonatal VUR without renal lesions and those diagnosed in older ages, generally in relation with urinary tract infection (UTI), have been published over the last decade. From the standpoint that VUR is part of a broad spectrum both in clinical expression as in pathogenesis, with different theories described to explain the existence of this type of congenital VUR in males. The existence of a fetal vesicourethral dysfunction, presenting after birth as a high risk bladder, which is defined by urodynamic tests in the first trimester, explains the appearance of severe fetal VUR with functional deterioration of one or both renal units at the time of birth; this entity must be diagnosed to establish the adequate therapeutic management. This clinical picture is named Valve like syndrome or male uncoordinated fetal voiding.

Reflujo vesicoureteral bilateral grave y nefropatía renal en pacientes varones recién nacidos: síndrome de válvulas-like o micción no coordinada en el feto varón / Severe bilateral vesicoureteral reflux and nephropathy in male newborns: valve-like syndrome or uncoordinated voiding in the male fetus

Diversos trabajos se han publicado en la última década, que diferencian el reflujo vesico ureteral (RVU) neonatal con afectación grave renal, de otro grupo mayoritario de neonatos con RVU neonatal sin lesión renal y los diagnosticados en edades más tardías generalmente relacionados con infección urinaria (ITU). Conviniendo en que el RVU forma parte de un amplio espectro tanto en la expresión clínica como por lo tanto de su patogénesis, se han descrito diversas teorías para explicar la existencia de este tipo de RVU congénito en varones. La existencia de una malfunción vesico uretral fetal, expresada postnatalmente con una vejiga de alto riesgo, definida ésta mediante estudio urodinámico en el 1º trimestre de vida extrauterina, explica la aparición de RVU grave fetal con afectación funcional de una o ambas unidades renales ya en el recién nacido y que precisa de su reconocimiento para un adecuado planteamiento terapéutico, éste cuadro lo hemos caracterizado como Síndrome de Válvulas-Like o Micción no coordinada fetal en el varón (AU)

Objectives: Various papers differentiating neonatal vesicoureteral reflux (VUR) with severe renal damage from other predominant group of newborns with neonatal VUR without renal lesions and those diagnosed in older ages, generally in relation with urinary tract infection (UTI), have been published over the last decade. From the standpoint that VUR is part of a broad spectrum both in clinical expression as in pathogenesis, with different theories described to explain the existence of this type of congenital VUR in males. The existence of a fetal vesicourethral dysfunction, presenting after birth as a high risk bladder, which is defined by urodynamic tests in the first trimester, explains the appearance of severe fetal VUR with functional deterioration of one or both renal units at the time of birth; this entity must be diagnosed to establish the adequate therapeutic management. This clinical picture is named Valve like syndrome or male uncoordinated fetal voiding (AU)

[Current status of the retroperitoneoscopic surgical approach in pediatric urology]. / Estado actual del abordaje retroperitoneoscopico en urologia pediatrica.

Urologic pediatric retroperitoneoscopy has had three different stages that have conditioned, although not hindered, its development: 1) limited number of indications in the pediatric age, because pediatric surgery itself is not much invasive; 2) adaptation of the technological development from adult to children; 3) overcoming the controversies between laparoscopic and non laparoscopic pediatric surgeons. After overcoming these stages, retroperitoneoscopy has become an indispensable tool for the treatment of various diseases of the kidney, being nephrectomy the gold standard among the indications for ablation, and pyeloplasty among reconstructive, through a complete or assisted retroperitoneoscopic approach.

Estado actual del abordaje retroperitoneoscopico en Urología Pediátrica / Current status of the retroperitoneoscopic surgical approach in pediatric urology

La retroperitoneoscopia urológica pediátrica presenta tres etapas diferenciadas que han condicionado su desarrollo, aunque no impedido: 1) limitadas indicaciones en la edad pediátrica, debido a que la cirugía pediátrica convencional se caracteriza por ser poco invasiva; 2) adecuación del desarrollo tecnológico realizado en el adulto a la edad pediátrica; 3) superar las controversias entre cirujanos pediátricos y no laparoscopistas. Tras superar ésta etapa, la retroperitoneoscopiase ha impuesto como herramienta imprescindible para el tratamiento de las diversas patologías de la celda renal, siendo de las indicaciones ablativos la nefrectomía su «gold estándar», y de las reconstructivas la pieloplastia, por abordaje retroperitoneoscopico completo o asistido (AU)

Urologic pediatric retroperitoneoscopy has had three different stages that have conditioned, although not hindered, its development: 1) limited number of indications in the pediatric age, because pediatric surgery itself is not much invasive; 2) adaptation of the technological development from adult to children; 3) overcoming the controversies between laparoscopic and non laparoscopic pediatric surgeons. After overcoming these stages, retroperitoneoscopy has become an indispensable tool for the treatment of various diseases of the kidney, being nephrectomy the gold standard among the indications for ablation, and pyeloplasty among reconstructive, through a complete or assisted retroperitoneoscopic approach (AU)