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Introduction. Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males. Varicocele diagnosis is important since it can induce testicular hypertrophy and fertility issues in adulthood. The objective of this study was to assess whether complications, including varicocele recurrence, depend on the vascular occlusion technique used -clipping + division vs. vascular sealer- in the laparoscopic Palomo technique used in our institution. Materials and methods. A longitudinal, prospective study was carried out from 2017 to 2021. Two therapeutic groups were created according to the vascular occlusion method used during laparoscopic varicocelectomy -clipping + division vs. vascular sealer. Patients were randomly allocated to the groups in a systematic alternating consecutive manner. Variables -age, varicocele grade according to the Dubin-Amelar classification, postoperative complications, follow-up, and varicocele recurrence-were analyzed according to the method employed. Results. A total of 37 boys, with a mean age of 12 years (10-15 years) and a mean follow-up of 12 months, were studied. In 20 patients (54.1%), clipping + division was used, and in the remaining 17 (45.9%), the vascular sealer was employed. 24.3% had symptomatic Grade II varicocele and 75.7% had Grade III varicocele. 32.4% of the children had postoperative complications during follow-up. 29.7% of the patients had hydrocele following surgery -8 boys from the sealing group and 3 boys from the clipping group-, with 13.5% requiring re-intervention as a result of this. None of the patients had varicocele recurrence. Conclusions. The laparoscopic Palomo technique is safe and effective, with good results in pediatric patients and few postoperative complications, regardless of the vascular occlusion device used. In our study, no statistically significant differences regarding the use of clipping or vascular sealer in this laparoscopic technique were found. However, further studies with a larger sample size are required to find potential differences. [ABSTRACT FROM AUTHOR]

Objectives. Orchiectomy is the most widely used surgical technique in testicular tumors (TT). However, according to tumor size, tumor markers, and histology, tumorectomy can be considered as the technique of choice, since these tumors are mostly benign. We present our experience with conservative surgery. Materials and methods. A retrospective study of 21 TT cases in 19 patients under 14 years of age treated in our healthcare facility from 1998 to 2018 was carried out. The following variables were analyzed: age, laterality, histological type, evolution, presence or absence of recurrence, and ultrasound and analytical follow-up. The therapeutic attitude used was reviewed while assessing the possibility of testicular preservation in selected patients. Results. Conservative surgery was performed in 9 TT cases in 7 patients (2 bilateral cases). Mean age was 6 years (0-13 years). 86% of cases started as an asymptomatic scrotal mass. No significant differences were found in terms of laterality. Tumor markers were negative before and after surgery, except in an infant with high alpha-fetoprotein, which was normalized in the postoperative period. The histological study diagnosed 7 stromal TTs (three Leydig cell stromal TTs, one bilateral Sertoli cell stromal TT, one hamartoma, and one fibroma) and 2 germ cell TTs (bilateral epidermoid cyst). Evolution was favorable in all cases, without clinical or ultrasound recurrence. Conclusions. Conservative surgery of the testicular parenchyma using tumorectomy can be the first therapeutic option in benign tumors and in selected patients with bilateral tumor, since it allows future hormonal and reproductive function to be preserved. [ABSTRACT FROM AUTHOR]

Introduction: Major Outpatient Surgery (MOS) is an organizational and management model for surgical care that allows selected patients to be treated efficiently and safely. Our objective was to evaluate the quality of the different activities through standardized quality indicators, analyzing whether they have been modified during the COVID-19 pandemic., Materials and Methods: An observational and comparative descriptive study of the quality indicators (QI) of MOS in our Pediatric Surgery Department from 2019 to 2020 was carried out. In accordance with the International Association for Ambulatory Surgery (IAAS) and the recommendations of the Spanish Ministry of Health and Consumer Affairs, we assessed the basic quality and the degree of family satisfaction of patients undergoing MOS., Results: A total of 848 and 652 interventions were performed in 2019 and 2020, respectively, with a mean age of 6 and 7 years. 539 (ambulatory rate (AR) 63.6%) and 465 (AR 71.3%) MOS surgeries were conducted in 2019 and 2020. In 2019, the overall substitution rate (SR) was 96.8%, hospitalization rate (HR) was 1.67%, suspension rate was 5.94%, and readmission rate was 1.48%. In 2020, the overall IS was 98.3%, HR was 0.86%, suspension rate was 4.73%, and readmission rate was 1.72%. No differences were found in terms of satisfaction between 2020 and 2019., Conclusions: QI allow us to know and analyze the performance and results of the different management units. In our department, the COVID-19 pandemic has not reduced the quality of CMA care.

Introduction: Congenital nephrourological abnormalities (CAKUT) are a particularly relevant group of diseases due to their high prevalence and the fact they are the main cause of chronic renal disease (CRD) in the pediatric population. Our objective was to determine the characteristics and prevalence of CAKUT in our setting, while identifying the factors associated with the occurrence of renal damage., Materials and Methods: A retrospective, descriptive, analytical, cross-sectional study of patients seen in the Pediatric Nephrology Department of a third-level hospital from January 1 to December 31, 2018 was carried out. Epidemiological, clinical, and analytical variables were assessed, and potential risk factors associated with CRD were searched for., Results: The study involved 685 patients with 827 kidney units affected by CAKUT with a mean age of 9.98 ± 5.12 years. 62.2% were male, and the mean follow-up period after diagnosis was 9.95 ± 5.09 years. 58.8% were non-obstructive dilations, followed by renal dysplasia, obstructive dilations, and number and position abnormalities. The most frequent malformation was vesicoureteral reflux (VUR). The most commonly affected side was the left (47.5%). 55% of the diagnoses were prenatal. 172 patients underwent surgery. The initially chosen treatment for VUR was endourological. Overall re-intervention rate was 20%. Of the total number of patients, glomerular filtration rate was analyzed in 383, 95 (24.8%) of whom had CRD (86% in stage 2). Male sex, bilaterality, and proteinuria were risk factors associated with CRD., Conclusions: Knowledge of the epidemiological and clinical characteristics of children with CAKUT and the factors associated with CRD helps to individualize the clinical follow-up of these patients, thus customizing diagnostic tests and healthcare resources.

Introduction: In pediatrics, there are few standard criteria to classify and consolidate postoperative complications, particularly in appendectomy, where according to the literature, complications range from 5% to 30%., Methods: A cross-sectional, observational, retrospective study of patients undergoing surgery as a result of suspected acute appendicitis (AA) from December 2018 to January 2020 was carried out. Complications were grouped and consolidated according to the Clavien-Dindo (CD) classification. Postoperative complications and factors involved were analyzed by conducting a bivariate and multivariate statistical study using SPSS statistical software, version 25., Results: A total of 124 patients were studied. Mean age was 9 years (3-14 years). 62% were boys, and 38% were girls. All patients underwent appendectomy - 80.6% through laparotomy, and 19.4% through laparoscopy. 20% of patients had postoperative complications, which were grouped according to the CD classification (p = 0.002). Most complications were included in the CD I group (64%). Collections treated with antibiotic therapy were included in the CD II group (28%). Intra-abdominal collections requiring re-intervention for drainage purposes were included in the CD IIIb group (8%). The main factors driving complications were complicated AA (81% gangrenous and perforated) (p < 0.001) and progression time (80% > 24 h of progression) (p = 0.036), which increased mean hospital stay by 7 ± 4 days (p = 0.016). 137 ± 37 CRP levels were associated with plastron identification (p < 0.001), whereas 109 ± 19 CRP levels were associated with peritonitis (p < 0.001)., Conclusions: The Clavien-Dindo classification allows post-appendectomy complications in pediatric surgery to be classified using a common language, by associating complication grade with treatment complexity.

Objectives: Orchiectomy is the most widely used surgical technique in testicular tumors (TT). However, according to tumor size, tumor markers, and histology, tumorectomy can be considered as the technique of choice, since these tumors are mostly benign. We present our experience with conservative surgery., Material and Methods: A retrospective study of 21 TT cases in 19 patients under 14 years of age treated in our healthcare facility from 1998 to 2018 was carried out. The following variables were analyzed: age, laterality, histological type, evolution, presence or absence of recurrence, and ultrasound and analytical follow-up. The therapeutic attitude used was reviewed while assessing the possibility of testicular preservation in selected patients., Results: Conservative surgery was performed in 9 TT cases in 7 patients (2 bilateral cases). Mean age was 6 years (0-13 years). 86% of cases started as an asymptomatic scrotal mass. No significant differences were found in terms of laterality. Tumor markers were negative before and after surgery, except in an infant with high alpha-fetoprotein, which was normalized in the postoperative period. The histological study diagnosed 7 stromal TTs (three Leydig cell stromal TTs, one bilateral Sertoli cell stromal TT, one hamartoma, and one fibroma) and 2 germ cell TTs (bilateral epidermoid cyst). Evolution was favorable in all cases, without clinical or ultrasound recurrence., Conclusions: Conservative surgery of the testicular parenchyma using tumorectomy can be the first therapeutic option in benign tumors and in selected patients with bilateral tumor, since it allows future hormonal and reproductive function to be preserved.