ABSTRACT
El varicocele es la dilatación varicosa de la vena espermática y del plexo pampiniforme. Se origina más frecuentemente en el lado izquierdo(10:1) como consecuencia de un mal funcionamiento o ausencia delas válvulas de la vena espermática izquierda. Entre marzo del 1999 y diciembre del 2009 se han recogido un total de 37 casos (17,9%) de los diagnosticados de varicocele en la población pediátrica de nuestro centro, que requirieron tratamiento. Mediante anestesia local se crea un acceso femoral empleando un catéter Simmons tipo I. Posicionamos la punta del catéter más allá de lostium de la vena espermática para realizar el venograma de la venarenal izquierda mediante la administración de contraste yodado, que fluirá de forma retrógrada hasta testes. La embolización se realizará através de la introducción de coils metálicos (aproximadamente de 6 a8) de 0.038 empleando un catéter hidrofílico de 4 o 5F.Del total de los 37 casos tratados, se consiguieron embolizar correctamente33 pacientes (89,2%), siendo necesario una reembolización entres casos (10,8%) de los que uno acabó en cirugía. Tan sólo en un caso(2,7%) se practicó cirugía por embolización incompleta (AU)
Varicocele consists of the varicose expansion of the spermatic vein. Its more frequently in the left side (10:1) as consequence of an evilfunctioning or absence of the valves of the spermatic left vein. Between March 1999 and December 2009 there have been gathered a total of 37cases diagnosed of varicocele in the pediatric population of our center. After a local anesthetic we created a femoral aproach. We advanceinto the left renal vein using a catheter Simmons type I and then we position the top of the catheter beyond the ostium of the spermatic veinto fulfil the renal left vein by means of the administration of contrastiodized and gonadal vein could be visualized using retrograde phlebography .Transcatheter embolization will carry out across the introduction of coils (approximately from 6 to 8) of 0.038 using a hidrofiliccatheter of 4 or 5F.Of the total of the 37 cases, we obtained correctly embolization in33 patients (89.2%), being necessary a reembolization in three cases(10.8%) of which one finished in surgery. Only in a case (2.7%) surgerywas practised for embolization incomplete (AU)
Subject(s)
Humans , Male , Child , Embolization, Therapeutic/methods , Varicocele/surgery , Blood Vessel Prosthesis , Anesthesia, Local , Retrospective StudiesABSTRACT
Varicocele consists of the varicose expansion of the spermatic vein. It's more frequently in the left side (10:1) as consequence of an evil functioning or absence of the valves of the spermatic left vein. Between March 1999 and December 2009 there have been gathered a total of 37 cases diagnosed of varicocele in the pediatric population of our center. After a local anesthetic we created a femoral aproach. We advance into the left renal vein using a catheter Simmons type I and then we position the top of the catheter beyond the ostium of the spermatic vein to fulfil the renal left vein by means of the administration of contrast iodized and gonadal vein could be visualized using retrograde phlebography. Transcatheter embolization will carry out across the introduction of coils (approximately from 6 to 8) of 0.038 using a hidrofilic catheter of 4 or 5F. Of the total of the 37 cases, we obtained correctly embolization in 33 patients (89.2%), being necessary a reembolization in three cases (10.8%) of which one finished in surgery. Only in a case (2.7%) surgery was practised for embolization incomplete.
Subject(s)
Embolization, Therapeutic/methods , Varicocele/therapy , Adolescent , Child , Embolization, Therapeutic/instrumentation , Equipment Design , Humans , MaleABSTRACT
BACKGROUND: The surgical correction of proximal severe hypospadias, especially those with penoscrotal transposition (penis buried in scrotum), represents a true challenge for paediatric surgeons. A sequential approach to their repair is widely accepted, to preserve the vascularization of the neourethra and to avoid injuries in penis covering. In our experience, we believe that all hypospadias, even those associated with penoscrotal transposition, can be repaired in one surgical time by using a vascularized flap from dorsal prepuce in one or two layers (mucosal portion for urethra and skin face for ventral island). MATERIALS AND METHODS: From 1997 until 2007, 88 patients with proximal severe hypospadias have been operated. 35 patients associated penoscrotal transposition. Since 2005, we introduced a modification consisting in drawing the incisions following the own cutaneous folds resulting from the fusion of the lateral folds in penis skin. RESULTS: We performed Duckett type urethroplasty in 10 patients, Onlay type flap in 74, Onlay with oral mucosa in 2 and vesical mucosa urethroplasty in 2 of them. The fistula rate needing surgical closure was 17% (15/88), urethral stenosis was present in 5 patients (5.7%, 1 vesical mucosa, 2 Duckett urethrolpasties and 2 Onlay flaps). Severe complications were represented by partial necrosis of the skin flap in 3 patients (3.4%) needing a reurethroplasty. 1 patient presented surgical wound infection without later problems. Before 2005, among the 22 patients with penoscrotal transposition, 5 needed a new cutaneoplasty, associated in 2 occasions to a dorsal Nesbitt plicature to obtain the complete penis alignment. From 2005 until now, None of the 13 patients presenting with penoscrotal transposition needed any posterior cutaneoplasty. The follow up goes from 1 month until 10 years (median 45 months). At present time, urine spurt shows a correct range in all cases and the penis is located out of scrotal bag except in one patient, waiting for a new plasty. DISCUSSION: In our experience, we believe that all of the hypospadias may be repaired in a unique surgical time, including those of them associated with buried penis. Modification on skin incisions design following penoscrotal lateral folds with mucocutaneous preputial flap is an excellent option both for urethroplasty and correcting penis transposition.
Subject(s)
Hypospadias/surgery , Child, Preschool , Humans , Infant , Male , Urologic Surgical Procedures, Male/methodsABSTRACT
Introducción: La corrección en un solo tiempo quirúrgico de los hipospadias proximales graves es un verdadero desafío para los cirujanos. Una aproximación secuencial en la reparación está ampliamente aceptada, a fin de preservar la vascularización de la neouretra y evitar lesiones en el recubrimiento del defecto peneano. En nuestra experiencia todos los hipospadias, incluso los que asocian una transposición penoescrotal, pueden repararse en un solo tiempo quirúrgico con un colgajo en una sola faz o en doble faz procedente del prepucio dorsal (porción mucosa para la uretra y cutánea para el recubrimiento ventral). Material y Métodos: De 1997 al 2007 se han intervenido 88 pacientes con hipospadias proximal grave. De ellos, en 35 se asociaba enterramiento o transposición penoescrotal. Desde el 2005 hemos introducido una modificación en la plastia cutánea que consiste en incidir lapiel siguiendo los restos de fusión de los pliegues cutáneos laterales. Resultados: El tipo de uretroplastia ha sido Duckett en 10, Onlay en74, Onlay con mucosa oral en 2 y uretroplastia con mucosa vesical en2. El porcentaje de fístulas que han precisado cierre quirúrgico es del 17%(15/88); estenosis uretral en 5 pacientes (5,7%): 1 mucosa vesical, 2 Duckett y 2 Onlay; necrosis parcial del colgajo cutáneo en 3 pacientes (3,4%). (..) (AU)
Background: The surgical correction of proximal severe hypospadias, especially those with penoscrotal transposition (penis buried inscrotum), represents a true challenge for paediatric surgeons. A sequential approach to their repair is widely accepted, to preserve the vascularization of the neourethra and to avoid injuries in penis covering. In our experience, we believe that all hypospadias, even those associated with penoscrotal transposition, can be repaired in one surgical time by using a vascularized flap from dorsal prepuce in one or two layers(mucosal portion for urethra and skin face for ventral island). Materials and methods: From 1997 until 2007, 88 patients with proximal severe hypospadias have been operated. 35 patients associated penoscrotal transposition. Since 2005, we introduced a modification consisting in drawing the incisions following the own cutaneous folds resulting from the fusion of the lateral folds in penis skin. Results: We performed Duckett type urethroplasty in 10 patients, Onlay type flap in 74, Onlay with oral mucosa in 2 and vesical mucosaurethroplasty in 2 of them. The fistula rate needing surgical closure was17% (15/88), urethral stenosis was present in 5 patients (5.7%, 1 vesical mucosa, 2 Duckett urethrolpasties and 2 Onlay flaps). Severe complications were represented by partial necrosis of thesk in flap in 3 patients (3.4%) needing a reurethroplasty. 1 patient presented surgical wound infection without later problems. Before 2005, among the 22 patients with penoscrotal transposition,(..) (AU)
