Tratamiento endoscópico del reflujo vesicoureteral en una unidad de cirugía mayor ambulatoria pediátrica / No disponible

Introducción: El reflujo vesicoureteral (RVU) es uno de los principales problemas urológicos del niño. Su incidencia oscila entre el 1 y el 3% de los niños sanos. Material y métodos: Se trataron un total 38 niños y se analizaron sus datos sobre edad, sexo, grado del reflujo, lateralidad y resultados del tratamiento endoscópico (TE) en los distintos grados de reflujo. Todos los niños fueron operados en un quirófano de la unidad de cirugía mayor ambulatoria (CMA), estudiándose sus complicaciones y su evolución postoperatoria. Resultados: Durante un periodo de 6 años se operaron un total de 38 pacientes con edades comprendidas entre 1 y 12años. El RVU fue bilateral en 24 (64%) pacientes y unilateral en14 (36%), reuniendo un total de 62 unidades renales o uréteres. En 29 niños (76%) con 46 uréteres refluyentes (74%) el reflujo desapareció totalmente después de un único TE. Nueve pacientes(24%) con 16 unidades ureterales (26%) recibieron un segundo TE, desapareciendo con éxito el reflujo en 7 niños (10 unidades ureterales), ascendiendo la proporción de éxito en la desaparición del RVU tras dos inyecciones de Deflux al 90% del grupo total deuréteres (56 de 62).Conclusiones: La resolución endoscópica del RVU se ha convertido en la mayoría de los centros pediátricos en el tratamiento de elección en el control del reflujo primario, no sólo por sus buenos resultados sino por la baja morbilidad postoperatoria y la dependencia directa con una unidad de CMA pediátrica, con las consiguientes ventajas para su manejo (AU)

Background: Vesicoureteric reflux (VUR) is a major urological problem in children. Its incidence ranges from 1 to 3% of healthy children. Material and methods: We treated a total of 38 children and analyzed their data on age, sex, reflux grade, laterality, and results of endoscopic treatment (ET) at the different grades of reflux. All children were operated on in the ambulatory surgical unit and we analyzed complications and postoperative evolution. Results: During a period of 6 years were operated on 38 patients aged 1 to 12. VUR was bilateral in 24 (64%) patients, unilateralin 14 (36%), for a total of 62 renal units or ureters. Refluxdis appeared, completely and after just 1 ET, in 29 children (76%)with 46 refluxing ureters (74%). Nine patients (24%) with 16 ureteral units (26%) received a second ET, reflux successfully disappeared in 7 children (10 ureteral units), changing the success rate in the disappearance of VUR after two injections of Deflux to90% of the total group of ureters (56 of 62).Conclusions: The endoscopic treatment of VUR has become the first choice for treatment in controlling primary reflux, not only due to its good results but also to its low postoperative morbidity and because it is performed in a Paediatric Ambulatory Unit with all its advantages (AU)

[Transitional cell tumor in a 12-year-old patient]. / Urotelioma vesical en paciente de 12 años.

Transitional cell papillomas, which are tumors of epithelial origin, are the most common urinary tract neoplasm in adults but are extremely rare in children. In both groups the main location is the bladder, often around one of the ureteric orifices. Symptoms vary widely but the most frequent is gross hematuria. Transitional cell papillomas are histologically low-grade tumors and total excision is considered curative. However the rate of recurrence in the literature is high, and there is a potential for a more aggressive type of tumor. We report the case of a 12-year-old girl who presented with a transitional cell papilloma near the right ureteric orifice and describe the etiopathogenesis, diagnosis, treatment and outcome of this entity.

Urotelioma vesical en paciente de 12 años / Transitional cell tumor in a 12-year-old patient

Los papilomas de células transicionales son tumores de origen epitelial, y forman las neoplasias del tracto urinario más frecuentes en los adultos, sin embargo su incidencia en la infancia es muy baja. La localización más común en ambos grupos es la vesical, a menudo en la proximidad de los orificios ureterales. La clínica posible es muy variable, siendo la más frecuente la hematuria macroscópica. Histológicamente son de bajo grado de malignidad, y la escisión radical es considerada curativa; sin embargo, la tasa de recurrencia en la literatura especializada es alta, y existe la posibilidad de un tipo tumoral más agresivo. Presentamos el caso de una niña de 12 años de edad que presenta esta rara lesión cercana al orificio ureteral derecho y se revisa la etiopatogenia, diagnóstico, tratamiento y evolución de esta entidad

Transitional cell papillomas, which are tumors of epithelial origin, are the most common urinary tract neoplasm in adults but are extremely rare in children. In both groups the main location is the bladder, often around one of the ureteric orifices. Symptoms vary widely but the most frequent is gross hematuria. Transitional cell papillomas are histologically low-grade tumors and total excision is considered curative. However the rate of recurrence in the literature is high, and there is a potential for a more aggressive type of tumor. We report the case of a 12-year-old girl who presented with a transitional cell papilloma near the right ureteric orifice and describe the etiopathogenesis, diagnosis, treatment and outcome of this entity

Lipoblastoma en la infancia / Lipoblastoma in childhood

El lipoblastoma es un tumor infrecuente del tejido embrionario, típico de la infancia y la adolescencia. Tiene un buen pronóstico por su limitada tendencia a infiltrar de forma local y generar metástasis, aunque su crecimiento es rápido y puede alcanzar grandes tamaños. Por este motivo, el tratamiento de elección es la excisión completa. Se presenta el caso de dos pacientes de 7 meses y 7 años, respectivamente, intervenidos quirúrgicamente por lipoblastoma localizado en sitios inusuales: uno, en la pared abdominal, y el otro, en el espacio paravertebral. Se procedió a la extirpación completa de las lesiones. No se observaron signos de malignidad y la evolución inmediata y el seguimiento a medio y largo plazo (3 años y 6 meses, respectivamente) fueron favorables

Lipoblastoma is an uncommon tumor of embryonal fat that occurs typically in infancy and childhood. It has an excellent prognosis,a nd does not behave aggressively or metastasize, but its growth is rapid and it can reach disconcerting proportions. For this reason, the treatment of choice is complete resection. Here we present two patients, 7 months and 7 years old, who underwent surgical excision for lipoblastoma at uncommon sites: abdominal wall and paravertebral space. The patients were normal at follow-up, with no evidence of metastases after 3 years and 6 months, respectively

[Subureteral polydimethylsiloxane injection for the endoscopic treatment of vesicoureteral reflux]. / Tratamiento endoscópico con polidimetilxilosano en el reflujo vesicoureteral.

INTRODUCTION: Endoscopic subureteral injection has been successfully used to treat vesicoureteral reflux (VUR) in children. The aim of this study was to review our results with subureteral polydimethylsiloxane injection in terms of effectiveness, long term follow-up and morbidity. MATERIAL AND METHOD: Twenty-eight children with VUR were treated with this technique. VUR was unilateral in eight patients (28.6%) and bilateral in 20 patients (71.4%). Indications for endoscopic treatment were the same as those for open surgery. The polydimethylsiloxane implant was injected transureterally below the ureteral meatus in 50 ureters on an outpatient basis. Reflux grade was low (II-III) in 36% and high (IV-V) in 64%. RESULTS: The mean follow-up was 18 months (12 months-4 years). VUR was corrected in 43 ureters (86%) corresponding to 21 patients. Reflux resolved in 40 ureters after one polydimethylsiloxane injection (80%) and in 43 ureters (86%) after two injections. An endoscopic retreatment to correct the reflux was performed in six ureteral units. Cystoscopic findings in these patients with endoscopic failure were mound displacement toward the bladder neck in five ureters and marked volume loss on the mound in one. All these patients underwent a second subureteral dose, which controlled VUR in three ureters (50%). CONCLUSIONS: Our results confirm that endoscopic subureteral polydimethylsiloxane treatment is a simple procedure with low morbidity that is well tolerated by the patient. In our experience, it can be used in double ureters. The effectiveness of this procedure seems to be related to the grade of reflux, the cystoscopic appearance of the ureteral orifice, volume loss and mound displacement.

Tratamiento endoscópico con polidimetilxilosano en el reflujo vesicoureteral / Subureteral polydimethylsiloxane injection for the endoscopic treatment of vesicoureteral reflux

Introducción: En la actualidad el tratamiento endoscópico es una alternativa válida en el reflujo vesicoureteral (RVU). El objetivo de este trabajo es analizar los resultados de nuestra experiencia en términos de eficacia, morbilidad y seguimiento a largo plazo en el tratamiento endoscópico del RVU con el uso del polidimetilxilosano. Material y método: Hemos utilizado este tratamiento en 28 niños que presentaban RVU unilateral en 8 casos (28,6 %) y bilateral en 20 pacientes (71,4 %). Las indicaciones para el tratamiento fueron básicamente las mismas que en el caso de la cirugía abierta. La inyección cistoscópica subureteral de polidimetilxilosano se aplicó en 50 unidades ureterales portadoras de un RVU bajo grado (II-III) en el 36 % de los casos y de alto grado (IV-V) en el 64%. Resultados: El tiempo medio de seguimiento fue de 18 meses (12 meses- 4 años). El RVU se corrigió en 43 unidades ureterales (86 %) que correspondieron a 21 pacientes. El tratamiento fue eficaz tras una inyección endoscópica en el 80 % de los casos (40 uréteres) y después de la segunda en el 86 % (43 uréteres). Se realizó una segunda cistoscopia en 6 unidades ureterales que no se curaron tras la primera aplicación y se encontró un montículo desplazado del meato uretral en 5 casos y un montículo muy reducido de tamaño en un caso. En todos ellos se aplicó una segunda dosis subureteral, que fue capaz de controlar el RVU en 3 uréteres (50 %). Conclusiones: El tratamiento endoscópico del RVU con dimetilpolixilosano es un método sencillo, con poca morbilidad y buena tolerancia por el paciente. En nuestra experiencia la coexistencia del RVU con duplicación no contraindica el tratamiento endoscópico. Su eficacia parece estar relacionada con el grado de reflujo, la apariencia cistoscópica del orificio ureteral, y con la cantidad y el desplazamiento de la sustancia inyectada en el espacio submucoso

Introduction: Endoscopic subureteral injection has been successfully used to treat vesicoureteral reflux (VUR) in children. The aim of this study was to review our results with subureteral polydimethylsiloxane injection in terms of effectiveness, long term follow-up and morbidity. Material and method: Twenty-eight children with VUR were treated with this technique. VUR was unilateral in eight patients (28.6 %) and bilateral in 20 patients (71.4 %). Indications for endoscopic treatment were the same as those for open surgery. The polydimethylsiloxane implant was injected transureterally below the ureteral meatus in 50 ureters on an outpatient basis. Reflux grade was low (II-III) in 36 % and high (IV-V) in 64%. Results The mean follow-up was 18 months (12 months-4 years). VUR was corrected in 43 ureters (86 %) corresponding to 21 patients. Reflux resolved in 40 ureters after one polydimethylsiloxane injection (80 %) and in 43 ureters (86 %) after two injections. An endoscopic retreatment to correct the reflux was performed in six ureteral units. Cystoscopic findings in these patients with endoscopic failure were mound displacement toward the bladder neck in five ureters and marked volume loss on the mound in one. All these patients underwent a second subureteral dose, which controlled VUR in three ureters (50 %). Conclusions: Our results confirm that endoscopic subureteral polydimethylsiloxane treatment is a simple procedure with low morbidity that is well tolerated by the patient. In our experience, it can be used in double ureters. The effectiveness of this procedure seems to be related to the grade of reflux, the cystoscopic appearance of the ureteral orifice, volume loss and mound displacement

Adenitis tuberculosa abdominal: a propósito de un caso / Abdominal tuberculous lympnadenitis: a case report

Se presenta el caso de una niña de 11 años con una masa pélvica izquierda calcificada, descubierta al practicar una radiografía abdominal tras consultar por dolor abdominal crónico y en cadera derecha reciente, y que corresponde a una adenitis tuberculosa granulomatosa paranexial izquierda caseificada y calcificada, en forma seudotumoral por confluencia de ganglios caseificados. Se expone un breve comentario acerca de la tuberculosis abdominal y un diagnóstico diferencial de las masas pélvicas y las linfadenitis granulomatosas mediante la exposición del diagnóstico diferencial del caso presentado y su diagnóstico final (AU)

[Diagnosis and treatment of neonatal hydronephrosis. Influence of prenatal diagnosis]. / Diagnóstico y tratamiento de la hidronefrosis neonatal. Influencia del diagnóstico prenatal.

OBJECTIVES: The objective was to study hydronephrosis, the most common renal malformation during the neonatal period. PATIENTS AND METHODS: We have studied 85 patients (119 renal units) with hydronephrosis. Prenatal and neonatal diagnosis were performed in 83% and 17%, respectively. Diagnosis was made by ultrasound, intravenous urography, voiding cystourethography and diuretic renogram. RESULTS: The malformations were as follows: Ureteropelvic junction obstruction (UPJ; 40 cases), obstructive megaureter (OM; 16 cases), non-obstructive megaureter (NOM; 9 cases), multicystic kidney (MK; 8 cases), renoureteral duplication (RD; 8 cases) and posterior urethral valves (PUV; 4 cases). Surgical treatment was undergone in 39 cases (14 with UPJ, 10 with OM, 4 with NOM, 4 with MK, 3 with RD and 4 with PUV). Thirty-seven of these cases had prenatal diagnoses. CONCLUSIONS: Conservative therapy was followed in 46 patients (26 with UPJ, 6 with OM, 5 with NOM, 4 with MK and 5 with RD). Thirty of these were prenatally diagnosed. Postnatal mean follow-up was 36 months, using diagnostic methods described previously. Seven cases died (1 from sepsis and 6 others from associated malformations) and 78 patients have good evolution after surgical and conservative treatments.

[Venography and percutaneous embolization of the spermatic vein with spring coil as treatment of the varicocele in childhood]. / Flebografía y embolización percutánea de la vena espermática mediante espiral metálica, como tratamiento del varicocele en la infancia.

The treatment of varicocele is controversial in boys and it is a contributing factor to male infertility. Recently it has been proposed that earlier therapy of a varicocele during this period may improve the prognosis of infertility. We review our experience with the diagnosis and management of left varicocele in 30 pediatric patients 6 to 15 years old. All patients had clinically palpable varicocele. All were managed under local anesthesia by spermatic venography and percutaneous transcatheter embolization of the internal spermatic vein with spring coils. All achieved satisfactory occlusion, and during the follow up from 13 years to 9 months there was only one recurrence, noted in a patient 6 months after the procedure. Internal spermatic venograms allowed precise coil placement relative to collateral veins which could cause recurrence. Complications developed were phlebitis of the pampiniform plexus, leading to swelling and erythema of the left scrotum and mild flank pain, these symptoms resolved without sequelae. This a safe and effective nonsurgical method of obliterating varicoceles in children.

[Surgery of lung metastasis in childhood]. / Cirugía de las metástasis pulmonares en la infancia.

From 1975 to 1987, we have operated 20 cases with lung metastases. They were 12 females and 8 males with ages between 1,6 and 12 years old (average of 5 years). The histology of the primary neoplasia was: 13 cases with Wilms' Tumors, 3 cases with Ewing's Sarcoma and 1 case with Neuroblastoma, Rhabdomiosarcoma, Hepatoblastoma and Neuroectodermic Tumor of Askin. We found 38 metastases and there were performed through a Thoracotomy 28 wedge resection, 7 pulmonary lobectomies and 3 biopsies. The operative mortality was 0%. The most frequent location of the lesion were on medium and lower lobule of the right lung. The survival was 70% (14 cases) after 4 years of average of the follow up. The survival for Wilms Tumors was 61% (8 cases) and all patients with Ewing's Sarcoma, Rhabdomiosarcoma, Neuroblastoma and Neuroectodermic Tumor of Askin were alive. The Thoracotomy is a useful method for therapy of tumors in children with lung metastases associated to chemotherapy and radiotherapy.

[Diuresis renography in the postoperative course of pyeloureteral stenosis]. / El renograma diurético en la evolución postoperatoria de la estenosis pieloureteral.

Ureteropelvic junction (UPJ) obstruction constitutes the most common form of upper urinary tract obstruction in children. We study the role of diuretic renography and its correlation with other diagnostic methods for postoperative evaluation of this malformation. We reviewed 13 patients, 10 males and 3 females aged 1 months to 15 years, and with right UPJ obstruction in six and left obstruction in seven. In all of them pre and postoperative IVP, abdominal ultrasound, diuretic renography, and pressure flow studies. Were performed our results demonstrated a non-correlation between the findings of excretory urogram, abdominal ultrasound and diuretic renography and a close relation between pressure flow studies and diuretic nephrography. This two last methods are good tools for assessment of UPJ obstruction.

[Etiopathogenic study of spontaneous perforation of the biliary tract]. / Estudio etiopatogénico de la perforación espontánea del árbol biliar extrahepático en el neonato. A propósito de tres casos.

Spontaneous perforation of extrahepatic bile duct is a rare entity, but is the second cause of surgical jaundice in the newborn period after biliary atresia. We review the etiological theories and three patients with this anomaly. Centrolobulillar cholestasis was present in all cases. Parietal ischemic necrosis was seen in one case, obstructive lesions (extrahepatic biliary atresia) in two and malformative lesions (choledochal cyst) in the last patient. A developmental error and a small circumscribed area of duct wall weakness have been the most accepted factors involved in its pathogenesis. However we have found histologic and morphologic evidence that ratify the obstructive and vascular lesions as relevant elements in the etiology of the spontaneous perforation of the biliary tract.