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Urethral polyps are a rare pathology that is usually diagnosed in childhood hematuria and obstructive urinary symptoms are the most common findings and transurethral resection is the best choice of the treatment. We report three cases, a 6-years-old boy and 9-years-old boy diagnosed and treated of posterior urethral polyp after showing hematuria and obstructive urinary symptoms, and a 2-years-old girl that showed to prolapse of urethral polyp.

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.

Retrospective study of 124 patients (average age: 3.8 years) with midpenile hypospadias: 48.3% (60 children), distal penile: 45.9% (57) and coronal 5.6% (7), of which the 25.8% (16) presented ventral curvature and the 4.8% (6) resulting from the complication of another previous technique. All of them were operated according to Snodgrass' technique, removing the catheter between the 6th and 7th day in most of them. The global rate of complications was of 12%: 9 fistulae (7.2%) and 6 meatal stenosis (4.8%). Aesthetic result was satisfactory in all cases, getting glans covered by foreskin in 57.3%.

Urachal cysts are congenital anomalies detected predominantly during the childhood. They are often diagnosed when an infection occur mimicking a variety of acute intra-abdominal or pelvic processes. We present a case in a 7-year-old female infant, diagnosed of infected urachal cyst. The embryologic origin of this anomaly, clinical features, diagnosis and treatment are discussed.

Objective: [corrected] To analize the clinical presentation, diagnosis and surgical management of congenital megaprepuce (CM)., Material and Methods: We have made a retrospective study of four cases of CM diagnosed and treated in our centre between october 1997 and april 2005. We studied the diagnosis and surgical treatment., Conclusions: CM is an infrecuent condition that can be confused with others pathologies. It's necessary to diagnose and treat it correctly.

Objective: To value the efficacy in endoscopic treatment of the vesicoureteral reflux (VUR)., Material and Method: We have realized a prospective study in patients with RVU treated with endoscopic polydimethylsiloxane, from January 1999 until December 2001, analyzing the results after an average pursuit of 30 months. We included 144 patients, 92 girls and 52 children, with 213 VUR (124 primary ones and 89 of secondary etiology). The initial efficacy of the treatment was defined as the finished absence of RVU in the isotopic cystography, realized three months after the puncture., Results: The global efficacy of the endoscopic treatment in secondary etiology reflux was lower than the reached one in the treatment of the primary RVU (77.7% against 86.2%) but the differences did not reach statistical significance (p=0,226). We do not also find significant differences on having compared the injected volume and the valuation of resolution of the ebb between the different causes of secondary RVU (p=0.361). We found recurrence in patients with RVU due to lower urinary tract dysfunction (4.34%)., Conclusions: Endoscopic treatment of the secondary VUR is a minimally invasive skill, presents scarce morbidity and it is effective in chosen patients. The risk of a long term recurrence is grater in VUR secondary to functional alterations (neurogenic bladder and functional instability), for what, pursuit has to be established according to the base pathology.

Introduction: Nowadays, around 1% of children suffer from vesicoureteral reflux (VUR), which represents a risk factor for long-term kidney damage. In the last decade, development in this field has shown that subureteric endoscopic injection of bulking agents for childhood VUR is an acceptable alternative unlike long-term antibiotic prophylaxis and open surgery., Objective: To establish the complications of childhood VUR endoscopic treatment., Material and Methods: A retrospective analysis was carried out for every patient treated endoscopically in our department from January 1999 to September 2003, with a total amount of 516 implants of submucous bulking agents. All patients were assessed with an ultrasound as a first diagnostic technique so as to establish the complications associated with it, especially ureteral obstruction and injected agent migration., Results: Out of 516 cases, Macroplastique was used in 455, Deflux in 44 and Polytef in 17. 10 patients (1.9%) (5 girls/ 5 boys), with ages ranging from 15 months to 11,4 years, presented some kind of complications (Macroplastique was used in 8cases and Deflux in 2). Among them, 5 were remarkable due to an ureterohydronefrosis, 2 of which needed a nephrostomy. 3 patients presented an implant migration, 1 epididymitis and 1 bladder edema., Conclusions: Endoscopic bulking agent injection has become a safe alternative to open surgery in childhood VUR management.

Objectives: To retrospectively review all cases of epididymal cysts registered over the last five years; 15 cases have been included. Simple epididymal cysts are a rare pathology in childhood, being most of them diagnosed in puberty. Currently, due to the scarce case series, there is not consensus about the most adequate therapy., Methods/results: Mean age at presentation was 11.5 yr. (1-16). 50% were diagnosed incidentally and 29% presented increased scrotal size. 46% of the cases had associated left varicocele (n = 6) and 26% had history of orchiepididymitis. Diagnosis was based on physical examination and confirmed by ultrasound. 40% of the patients underwent surgery and the remainder received conservative treatment without evidence of complications on follow-up., Conclusions: Due to the benign character and good evolution of all cases of epididymal cysts treated conservatively and the absence of benefit after surgical treatment, we believe that management should be conservative with clinical and ultrasound controls, leaving surgery for cysts with complications. The frequent association between epididymal cysts and varicocele is related to coincidence of both pathologies in the prepuberal age.

Hemorrhagic infarction of the testicle is an unusual occurrence in the newborn infant. It usually develops as a consequence of torsion of the spermatic cord. We report a case of global testicular infarction in a newborn associated with a tense hydrocele.

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.

Epidermoid cysts of the testis are rare in children (3% of all the testicular tumors). Bilateral appearance has only been described in the pediatric age in 2 cases and none associated to Klinefelter's syndrome. We present, for our knowledge, the first case of bilateral epidermoid testicular cyst associated to klinefelter's syndrome in a boy, highlighting its management and therapeutic approach. We analyze the different kinds of treatment.

Introduction and Objectives: Cutaneous vesicostomy (CV) is a choice temporary urinary diversion technique for patients with upper urinary tract (URT) dilation, secondary to vesical o infravesical disease. The objective of this study is to share our experience in children undergoing such diversion, analysing its efficacy to prevent urinary infections, improve or resolve the ureterectasia, and stabilise or improve renal function; in short the functional and morphological recovery of URT., Material and Methods: 43 children, mean age 2.5 years (range: 1 month-14 years) with ureterohydronephrosis grade IV-V, persistent urinary infection and/or renal function impairment underwent cutaneous vesicostomy (Blocksom's technique in 36 and Lapides' procedure in the rest). Thirty subjects had neuropathic bladder (26 with secondary vesicoureteral reflux), 7 massive primary vesicoureteral reflux, and 6 posterior urethral valve., Results: All children (100%) with neurogenic bladder (30 cases), showed improvement of ureteral-pyelic-calyceal ectasia after the diversion, and 90% improved renal function with disappearance of vesiculoureteral reflux in 65%. Augmentation cystoplasty with gut was performed in 12 patients during vesicostomy closure, using Mitrofanoff's type diversion in 5 of them. The same continent diversion with cecal appendix was used in another 7 children as the only procedure. The remaining 11 children still retain their vesicostomy. In 5 of the 7 children with primary vesicoureteral reflux, the reflux disappeared and so the vesicostomy was closed. Reflux correction during the same surgical procedure was required for the other 2 children. Of the 6 children with posterior urethral valves, 2 received a renal transplant, one is in waiting list and the rest (50%) maintain an acceptable renal function. In the first year of follow-up, 4 patients developed symptomatic urinary infection that later disappeared. The rest had occasional asymptomatic bacteriuria that required no treatment. Complications included vesical prolapse due to ostomy in 4 patients, lithiasis in 3 and stomal stenosis in 2., Conclusions: We consider vesicostomy to be the choice urinary diversion technique in cases of common section obstruction and/or non-obstructive ureterohydronephrosis in new-borns who do not improve with conservative treatment.

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.

Objective: To discuss the current aspects and the impact of innovations on the clinical, diagnostic and therapeutic aspects of vesicoureteral reflux (VUR)., Methods: The literature on Medline over the last five years are reviewed and the urodynamic findings in our series of children with VUR are analyzed., Results: Fetal VUR and those diagnosed in children with a family history are currently considered to be the most interesting study groups from the clinical perspective. Renal scintiscanning, isotope-labelled cystography and urodynamic evaluation are well-established diagnostic methods that permit selecting the most appropriate treatment for patients with this anomaly. In our experience, 50.8% of the 128 patients in whom a urodynamic study was performed, showed changes in lower urinary tract function. Innovations in open surgery have been scanty and endoscopic treatment is increasingly utilized, although the search continues for the ideal biological material., Conclusions: The new diagnostic methods utilized in the evaluation of children with VUR will permit a better understanding of the natural history of this anomaly lead to changes in the protocols that are currently used.

Contribution of two cases of renal adenocarcinoma in pediatric patients. Comments on the most updated and relevant aspects of epidemiology, clinical manifestations, diagnosis, treatment, prognosis and follow-up. Comparison to nephroblastoma and renal adenocarcinoma of the adult.

Rationale: The purpose of our work is to know the prevalence of allergies to latex in patients with myelomeningocele (MMC) and to evaluate any potential factors influencing its development., Methods: The study included 100 children with mean age 7.5 +/- 4.8 years, diagnosed with MMC by skin tests and total and latex-specific IgE determination. The results were compared to those obtained in three "control" groups: atopic patients, patients undergoing their first operation and multi-operated patients. The relationship between the different variables analyzed was assessed using univariant and multivariant statistical studies., Results: 29 were sensitized (15 symptomatic and 14 asymptomatic) and 8 doubtful. Results showed statistically significant (p < 0.05) differences for atopic and first operation groups and non significant differences for the multi-operation group. The multivariant study selected the followed as the most relevant variables: number of surgical interventions, total IgE levels in z units, ventricle-peritoneal by-pass carriers and atopy background. Also in the multivariant study, the following showed statistically significant results: age, Cums' number, inclusion in intermittent catheterism program and total IgE levels. Neither sex or familial background of atopy showed statistical significance., Conclusions: Allergy to latex in MMC patients is related to multiple antigen contacts, the numerous manipulations and operations undertaken throughout the patient's life plus a personal propensity to allergies. It is essential that this group should adopt certain standards to minimize contact with the antigen and undergo an allergological study so as to detect those who are sensitized, which in nearly half our series has not yet exhibited symptomatology in contact with latex utensils. All diagnostic and therapeutical procedures should be conducted in latex-free environments.

Objectives: To evaluate the upper urinary tract morphology and function in children undergoing vesicostomy for different causes., Methods: We report on 27 children aged 1 month to 12 years who had undergone a Blocksom vesicostomy procedure. Twenty had a neuropathic bladder and 3 had posterior urethral valves., Results: In the 20 children with neuropathic bladder, renal function improved in 95% and the associated vesicoureteral reflux improved in 56%. The morphology of the upper urinary tract returned to normal prior to the definitive operation in all cases. Only one of the patients with posterior urethral valves has preserved satisfactory renal function two years following vesicostomy. The most common complication was prolapse (14.8%)., Conclusions: In our view, vesicostomy is the best urinary diversion procedure in the cases described herein. Vesicostomy closure must be performed following definitive treatment of the underlying condition, except in those cases with neuropathic bladder who require augmentation cystoplasty to keep upper urinary tract pressures low.

Presentation of a review of 10 paediatric patients with tumour of the testis vitelline sack, to report our experience in the management of this pathology. Mean age was 20 months (14-32), and the interval of the study was from 1970 to 1994. After orchiectomy, 7 children were included in stage I, 1 in stage II, and 2 in stage III. Four underwent Retroperitoneal Lymphadenectomy. All patients in stage I are currently free of disease, with a mean follow-up of 132 months, regardless the type of treatment employed (vigilance in 2 cases, chemotherapy in 2, and chemotherapy plus Retroperitoneal Lymphadenectomy in 3). On the contrary, the 3 children with extratesticular disease died 15, 18 and 15 months after orchiectomy. In conclusion, we believe that patients included in stage I should undergo only a strict vigilance, based on the excellent prognosis of this group and the lack of differences between the survival time obtained with the various therapeutical approaches followed. On the other hand, patients with stage II or stage III disease should receive from the beginning chemotherapy, thus saving the Retroperitoneal Lymphadenectomy for the residual disease.

Between 1970 and 1993, five children with paratesticular rhabdomyosarcoma (PR) and age ranging from 3 to 10 years were treated by our group. Following radical orchidectomy and clinical staging, 4 were rates as Group I-IRS (completely resected local disease) and 1 in Group IV-IRS (distant metastasis). All patients in Group I underwent intensive chemotherapy with vincristine, actynomicin D and cyclophosphamide (VAC) for 18 months, while no case of retroperitoneal lymphadenectomy was performed. Currently, all patients are disease free with a mean follow-up of 8 years and 5 months. The single patient included in Group IV received radiotherapy (800 rads in abdominal field) and chemotherapy with VAC + prednisone (PDR), and retroperitoneal lymphadenectomy of residual masses was performed. The patient developed liver metastasis and died 20 months later. The purpose of this paper is to convey the reader our experience in the treatment of PR in children, making a special reference to the excellent prognosis when the disease is limited to the scrotum and recommending in such cases the use of intensive chemotherapy with VAC after performing radical orchidectomy.

Seven cases with neonatal urinary ascites are described. In all of the cases the underlying cause was an anatomical or functional obstructive uropathy of the lower urinary tract, the most common pathology being neurogenic bladder secondary to lumbosacral dysphagia. The techniques utilized for patient evaluation (ultrasound, serial micturition cystourethrography and IVP) are described and the findings afforded by each diagnostic technique are presented. The value of serial micturition cystourethrography is underscored. In our view, it is convenient to perform initial diversion by percutaneous nephrostomy, suprapubic punction or placement of a urethral catheter, according to the level of the etiologic process. The definitive surgical approach will depend on the results of subsequent radiologic controls and the existing uropathy.

We reviewed our series comprised of 106 children that had undergone surgery for congenital hydronephrosis from ureteropelvic junction obstruction. Following our protocol, all patients were evaluated by serial micturition cystourethrography. The only anomaly that had been detected was vesicoureteral reflux in 11.32% of the cases. This incidence is reduced to 8.25% if only the renoureteral systems with both congenital anomalies are considered. This finding is not statistically significant (p less than 0.05) relative to patient age, sex or clinical symptoms. The results of the present study show that children with ureteropelvic junction obstruction are not at risk of developing vesicoureteral reflux. Thus, routine serial micturition cystourethrography appears to be unwarranted.

This paper reviews the surgical procedure performed in 119 kidneys (114 children), diagnosed with congenital hydronephrosis due to pyeloureteral juncture stenosis (PUJS). Approaches used for diagnosis and choice of surgical techniques are commented. Puncture/nephrostomy with functional kidney assessment has been the method selected in extreme cases. Nephrectomy was the chosen option in 8 cases (6.7%) while conservative surgery was indicated in the others. Anderson-Hynes dismembered pyeloureteral plasty was the technique used in 110 cases with a 97.28% rate of success. Post-operative occurrences are commented and are related to the presence of pre- and post-operative derivation.

A case of retroperitoneal abscess with appendicular origin is presented. Both diagnostic process and therapeutic approach is analyzed. We also review the literature on cecal appendix pathology and its relationship to the urinary tract.

Laparoscopy has been performed in 68 infants and children. In 50 cases of non-palpable testis; 7 cases of liver diseases; 4 cases of abdominal trauma; 7 cases for various other indications. In our experience, laparoscopy was a considerable advantage in the diagnosis and management of a number of pediatrics disorders.

The angiomas studied at the Clinica Infantil "La Fe" in a four and a half years period are reviewed. The different therapeutic approaches are considered. Thirteen cases selected at random have been treated with local injections of steroids, with a 84% satisfactory results. The technique seems to be simple and without complications. It is recommended in the management of the parotideal, small size, subcutaneous and those angiomas in which the therapy could be followed by sequelae and in those where other therapy has failed.