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Resumen Introduccion La vejiga neuropatica (VN) es una disfuncion del tracto urinario inferior (DTUinf) con riesgo de deterioro de la funcion renal, siendo el estudio urodinamico (EUD) la prueba patron para su diagnostico y seguimiento. El parametro urodinamico clasico para identificar el riesgo renal es la presion de fuga del detrusor > = 40 cmH2O, aunque este valor aislado puede carecer de interes pronostico. Recientemente se ha descrito el area bajo la curva (ABC) del trazado de la presion del detrusor como factor pronostico. Objetivo Analizar la utilidad clinica del ABC del trazado de la presion del detrusor en edad pediatrica ( Metodos Estudio retrospectivo de registros urodinamicos en poblacion pediatrica con VN entre 2011-2020. Se registran: presion detrusor y de fuga ≥ 40 cmH2O, alteracion de la acomodacion, vaciado e hiperactividad detrusor. Se clasifica la muestra segun evolucion clinica-radiologica en el momento del EUD. Se calcula el ABC utilizando los metodos de Newton-Cotes (trapecios, Simpson compuesto) y se calculan sus indices segun la capacidad vesical (indice trapecios [IT]; indice Simpson [IS]). Significacion estadistica: p Resultados Se analizan 55 registros. El 41,8% (n = 23) tuvo una evolucion clinica desfavorable. La alteracion en el vaciado, la hipoacomodacion y los indices se asociaron a una situacion clinica desfavorable(p 0,05). Conclusiones Los nuevos indices estudiados son utiles en el diagnostico de pacientes con VN y situacion clinica desfavorable.

Introduction Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3–1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. Patients and methods Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. Literature review. Results A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. Conclusions High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

Resumen Introduccion El priapismo consiste en una ereccion mantenida durante mas de cuatro horas. Es una patologia infrecuente en la poblacion pediatrica, estimada en 0,3 a 1,5 por cada 100.000 ninos al ano. La secuencia diagnostica incluye anamnesis, exploracion fisica y ecografia doppler peneana (EcoDP). No siempre es necesaria la puncion de cuerpos cavernosos para establecer el diagnostico diferencial entre priapismo de alto y bajo flujo. El tratamiento de eleccion en la edad pediatrica no esta bien definido. Material y metodos Estudio multicentrico, retrospectivo, descriptivo de pacientes menores de 14 anos con priapismo de alto flujo, entre los anos 2010 y 2020. Revision de la literatura. Resultados Un total de siete pacientes fueron diagnosticados de priapismo de alto flujo. Ninguno requirio puncion de cuerpos cavernosos. Se realizo un manejo conservador en todos ellos, dos pacientes necesitaron embolizacion arterial superselectiva por persistencia de la clinica. Conclusiones El priapismo de alto flujo es una entidad muy infrecuente en la edad pediatrica por lo que es importante conocer el diagnostico y manejo adecuados. Actualmente, la ecografia doppler suele ser suficiente para el diagnostico, obviando el uso de la gasometria. El manejo inicial en ninos es conservador, reservando la embolizacion para los casos refractarios.

Objective To measure the tolerance of urodynamic testing (UDT) in the pediatric patient by means of the Visual Analog Scale (VAS). To analyze which clinical and UDT-related variables influence pain perception. Material and methods. Cross-sectional study of 139 pediatric patients undergoing UDT (December 2013 - May 2018). Inclusion criteria: understanding and expressing their experience after UDT (preschool and school age). No adolescents were included. Measurement instrument Visual Analog Scale (0−10). Other clinical and UDT-associated variables were obtained. Statistical analysis: Mann-Whitney U test, Kruskal Wallis test. Spearman’s rank correlation analysis (rs). Multivariate analysis through ordinal logistic regression. Significance p Results Mean age 7.7 years (SD 2.4), median VAS score, 2 (2–6). In 41% (n = 57), the score was ≥ 4 (moderate pain). Multivariate analysis. Explanatory variables for obtaining a high VAS score: high APUDT score (identifying patient anxiety prior to UDT), sensory-motor alteration in the lower limbs, difficult bladder catheterization and the appearance of pain during the filling phase. Age and duration of the UDT have not influenced the VAS score. Conclusions Although the UDT has resulted in 40% of the pediatric patients in our study expressing discomfort or pain, it is a well-tolerated test. The variables that have influenced on pain perception were patient’s anxiety prior to UDT, a sensory-motor alteration located in the lumbosacral metameres, difficult bladder catheterization and the appearance of pain during bladder filling.

Resumen Objetivo Medir la tolerancia del estudio urodinamico (EUD) en el paciente pediatrico, mediante una escala visual analogica. Analizar que variables clinicas y relacionadas con el EUD influyen en la percepcion del dolor. Material y metodos Estudio transversal de 139 pacientes pediatricos tras un EUD (entre diciembre del 2013 a mayo del 2018). Criterio de inclusion: entender y expresar su experiencia tras el EUD (edad preescolar y escolar). No se incluyeron adolescentes. La herramienta de evaluacion: escala visual analogica del dolor (EVA 0-10). Se obtuvieron otras variables clinicas y asociadas al EUD. Analisis estadistico: U de Mann-Whitney, Kruskal-Wallis. Analisis de correlacion de Spearman (rs). Analisis multivariante mediante regresion logistica ordinal. Significacion p Resultados Media de edad 7,7 anos (DE 2,4), mediana puntuacion EVA, 2 (2-6). En un 41% (n = 57), la puntuacion fue ≥ 4 (dolor moderado). Analisis multivariante. Variables explicativas de obtener una puntuacion EVA alta: puntuacion APEUD alta (identificar en el paciente nerviosismo previo al EUD), alteracion sensitivo-motora de MMII, una dificultad en el sondaje vesical y que aparezca dolor durante el llenado. La edad y el tiempo de duracion del EUD no han influido en dicha puntuacion EVA. Conclusiones Aunque el EUD ha generado que un 40% de los pacientes pediatricos de nuestro estudio expresaran molestias o dolor, es una prueba bien tolerada. Las variables que han influido en la percepcion del dolor han sido: el nerviosismo del paciente previo al EUD, una alteracion sensitivo-motora localizada en metameras lumbosacras, una dificultad en el sondaje vesical y que aparezca dolor durante el llenado vesical.

Resumen Objetivos Analizar si existe mayor prevalencia de trastornos del sueno y desordenes en su higiene en los pacientes con enuresis monosintomatica (ENM) con respecto a la poblacion general y a los pacientes con ENM corregida. Valorar la utilidad de la escala de cribado de trastornos del sueno en la infancia BEARS en la ENM. Material y metodos Estudio observacional transversal (n = 341) clasificados en: ENM (n = 122), ENM corregida (> = 1 a un ano sin recidiva) (ANTENUR) (n = 47) y controles (n = 172). Se utilizo el cuestionario de cribado de trastornos del sueno en la infancia BEARS. Se recopilaron variables clinicas, asi como variables en referencia a la higiene del sueno. Estadisticos: chi cuadrado, t de Student, ANOVA, U Mann-Whitney y Kruskall-Wallis. Significacion p Resultados Media de edad 9,7 ± 3,0 anos. No existieron diferencias estadisticamente significativas con respecto a edad, genero, IMC, antecedente de amigdalectomia, asma y numero de horas de sueno. Con respecto a la higiene del sueno, los pacientes con ENM presentaron mayor porcentaje de alteraciones con respecto a los controles. En cuanto al cuestionario BEARS, demostro mayor prevalencia de alteraciones del sueno en el grupo de pacientes con ENM, con respecto a los otros dos grupos. Un 60,7% (n = 74) frente al 18,6% (n = 32) y el 38,3% (n = 18) de los controles y ANTENUR, respectivamente (p Conclusiones Los ninos con ENM presentaron mayor prevalencia de desordenes durante el sueno asi como en la higiene de este, con respecto a los controles. El cuestionario BEARS es una herramienta clinica util en la deteccion de los desordenes del sueno en el nino.

Introduction: Multilocular cystic nephroma (MCN) is a type of benign renal tumor that is sometimes misdiagnosed with cystic Wilms Tumor. Given that each one has a different treatment, it is essential to make a proper diagnosis. Objective: Our aim was to find the differential characteristics of MCN and to be able to identify these renal masses with low probability of malignancy, which are subsidiaries of a more conservative treatment. Material and Methods: We conducted a retrospective descriptive study were we analyzed the patients with MCN treated in our center between 1971 and 2016. Results: We found 13 patients with a histological diagnosis of MCN, mostly males, with an average age of 46.8 months at the time of surgery. Clinically, 2 cases (15.4%) were asymptomatic, 6 had an abdominal mass (46.1%), 3 had abdominal pain (23.1%) and 2 had hematuria (15.4%). The maximum diameter of the mass was 7.3 cm (mean). 9 nephrectomies (69.2%) and 4 tumorectomies (30.8%) were performed. In two of these (15.4%), neoadjuvant chemotherapy was administered due to presurgical suspicion of Wilms' tumor, which was discontinued after the pathological analysis. In another 4 patients with suspicion of MCN, all of them asymptomatic and with a tumor size

Congenital mesoblastic nephroma (CMN) is the most common type of renal tumor in the neonatal period. It is rare in the general population and usually benign, and the treatment protocol is poorly defined. The aim of the present study is to present a retrospective analysis of the cases of mesoblastic nephroma treated at our centre during the last 26 years. A retrospective study was conducted of 11 patients diagnosed with congenital mesoblastic nephroma between 1st January 1990 and 30th September 2016 at our centre. A review of the patients’ clinical records was carried out, analysing the demographic, clinical, diagnostic, therapeutic, survival and follow-up variables. Nine (81.8%) were males; one patient was diagnosed prenatally, 9 patients in the first three months of life, and one patient when he was two years old. The most common presentation was a palpable abdominal mass in 10 patients, 2 had haematuria, 6 of them had arterial hypertension, and one had hypercalcaemia. The pathological findings were: 3 cases classic of classic CMN type, 4 mixed type and 4 cellular type. Regarding the tumor stage, 7 patients were at stage I, 3 were at stage II and 1 was at stage III. In all patients, the treatment of choice was radical nephrectomy, and 3 patients received neoadjuvant chemotherapy. Only one patient presented a local recurrence and all of the patients are still alive without any death related to the tumor. CMN is a rare renal tumor but it is considered the most frequent renal tumor in the neonatal period, generally of benign behaviour, but recurrence is possible, and its obstetric and perinatal complications can compromise life.

Objectives To assess the diagnostic performance of urinary dysfunction patterns associated with vesicoureteral reflux (VUR) in children over the age of 3 according to the result of the first endoscopic treatment (ENDT1), grouped into a classification designed by our group (CMD.URI-La Fe). Comparison with other current classifications such as that of Van Batavia et al. Material and methods Ambispective cross-cutting study of a sample of 50 children. Exclusion criteria: previous ENDT, age ≤ 3 years, anatomical or neurological anomalies and a history of ureteral or abdominopelvic surgery. Prior to the ENDT1, a bladder voiding function assessment by uroflowmetry + electromyography (UF-EMG) and post-mictional residue (ultrasound). Other variables from the bladder diary, pre-mictional bladder wall thickness and other clinical variables. The correction of VUR was assessed by isotope cystography 3 months after the treatment. Urinary patterns were classified according to the significant variables (URI-La Fe), and the diagnostic performance of this classification was assessed, comparing it to the classification of patients as proposed by Van Batavia et al. Results Mean age: 6.8 ± 2.28 years. Males/females (44%/56%). Grades of VUR (mild/moderate/severe). ENDT1 VUR correction rate: 77% (n = 38). Diagnostic performance (Van Batavia; URI-La Fe): correct prediction (37.5%; 75%), sensitivity (32.4%; 87.8%), specificity (54.5%; 46.6%), positive predictive value (70.6; 78.3%) and negative predictive value (19.4%; 63.6%). Conclusions Our results show the usefulness of the non-invasive test and the classification of urinary dysfunction in children aged over 3 years prior to the first endoscopic treatment of VUR.

Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined.Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020.A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms.High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

Spermatic vein thrombosis is a very rare pathology, with 25 cases published only, 6 of which in patients under 15 years of age. We present the case of a male patient, as well as a review of the literature. A 12-year old boy presented at emergency with 3-day progressive testicular pain. Following abdominal Doppler ultrasound imaging, he was diagnosed with left spermatic vein thrombosis and nutcracker syndrome. Admission and enoxaparin treatment were decided upon. Patient evolution was satisfactory, with subsequent ultrasound imaging demonstrating the absence of thrombus. The patient is currently under follow-up and without treatment. Various treatments are mentioned in the literature, with conservative management being the treatment of choice.La trombosis de la vena espermática es una patología muy poco frecuente, con solo 25 casos publicados, 6 de los cuales menores de 15 años. De esta manera presentamos el caso de un varón, así como la revisión de la literatura. Un paciente de 12 años de edad acudió a Urgencias por dolor testicular de aumento progresivo, de 3 días de evolución. Mediante ecografía doppler abdominal se diagnosticó de trombosis de la vena espermática izquierda y síndrome de cascanueces. Se decidió ingreso y tratamiento con enoxaparina. La evolución del paciente fue satisfactoria, en la ecografía posterior se observó la desaparición del trombo. El paciente se encuentra en seguimiento y sin tratamiento. Existen varios tratamientos reflejados en la literatura, siendo el de elección el manejo conservador.

Spermatic vein thrombosis is a very rare pathology, with 25 cases published only, 6 of which in patients under 15 years of age. We present the case of a male patient, as well as a review of the literature. A 12-year old boy presented at emergency with 3-day progressive testicular pain. Following abdominal Doppler ultrasound imaging, he was diagnosed with left spermatic vein thrombosis and nutcracker syndrome. Admission and enoxaparin treatment were decided upon. Patient evolution was satisfactory, with subsequent ultrasound imaging demonstrating the absence of thrombus. The patient is currently under follow-up and without treatment. Various treatments are mentioned in the literature, with conservative management being the treatment of choice.

A calyceal diverticulum consists of a cystic eventration in the renal parenchyma that is lined with transitional cell epithelium with a narrow infundibular connection with the calyces or pelvis of the renal collector system; thus, the term pyelocalyceal diverticulum would be more accurate. Very rare in pediatric patients, calyceal diverticula can be symptomatic and require treatment. Calyceal diverticula are underdiagnosed because they can be mistaken for simple renal cysts on ultrasonography. To determine the approach to their follow-up and management, the diagnosis must be confirmed by excretory-phase computed tomography (CT) or magnetic resonance imaging (MRI). This article aims to show the different ways that calyceal diverticula can present in pediatric patients; it emphasizes the ultrasonographic findings that enable the lesion to be suspected and the definitive findings that confirm the diagnosis on CT and MRI. It also discusses the differential diagnosis with other cystic kidney lesions and their treatment.

Resumen El diverticulo calicial (DC) es una eventracion quistica intraparenquimatosa tapizada por epitelio celular transitorio con una estrecha conexion infundibular con los calices o pelvis del sistema colector renal, por lo que el termino mas exacto es diverticulo pielocalicial. Muy raro en la edad pediatrica, puede ser sintomatico y requerir tratamiento. Esta infradiagnosticado por confundirse con quistes renales simples por ecografia; su diagnostico se confirma con tomografia computarizada (TC) o resonancia magnetica (RM) en fase excretora, para determinar su seguimiento y manejo. Nuestro objetivo es mostrar las diferentes formas de presentacion de los DC en la edad pediatrica, haciendo hincapie en los criterios ecograficos que permiten una aproximacion diagnostica y en los hallazgos definitivos en TC y RM. Tambien discutimos el diagnostico diferencial con otras lesiones quisticas renales y su tratamiento.

Xanthogranulomatous pyelonephritis (XPN) is an unusual and severe form of chronic inflammatory lesion of the kidney, characterised by the destruction of the renal parenchyma and the presence of multinucleated giant cells and lipid-laden macrophages, inflammatory infiltration and intensive renal fibrosis. There are a few cases in the literature which describe the disease in children. The pathomechanism of XPN is poorly understood. Renal obstruction with concomitant urinary tract infection is the most commonly associated pathological finding. The process is typically unilateral and may be focal or diffuse. In both cases, the perirenal infiltration is possible and can be mistaken for common renal neoplasm or inflammatory process. The symptoms are non-specific. Diagnostic imaging techniques with clinical suspicion have enabled XPN to be diagnosed and differentiated from malignancy with a high degree of confidence. Computed tomography (CT) is the mainstay of diagnostic imaging. The definitive diagnosis of XPN is based on pathological assessment after nephrectomy. We review and illustrate the clinical, radiological, surgical and pathological characteristics of XPN in children. All cases shown are surgically and histopathologically proven. • XPN can present different clinical manifestations. • CT is the mainstay of diagnostic imaging in XPN. • Focal type of XPN should be included in the differential diagnosis of children with a renal mass. • There are no clear guidelines on the management of XPN. • Conservative and surgical treatments should be considered for each individual case. • Histopathological examination confirms the diagnosis and excludes other benign and malign diseases.

Resumen Objetivos Evaluar la necesidad de la realizacion de la gammagrafia renal en el diagnostico de la displasia renal multiquistica (DRMQ), asi como la seguridad de su tratamiento conservador. Material y metodos Estudio retrospectivo de los pacientes con DRMQ unilateral en nuestro centro desde enero de 2005 hasta agosto de 2015. Calculamos el valor predictivo positivo (VPP) de la ecografia tomando la gammagrafia renal y la anatomia patologica como gold standard . Realizamos una curva de supervivencia segun el metodo de Kaplan-Meyer para evaluar la probabilidad de resolucion espontanea del RM anualmente. Resultados Se han identificado 56 pacientes, 48 (85,7%) con diagnostico prenatal, 38 (67,9%) fueron varones y en 33 (58,9%) el lado afecto fue el izquierdo. En 22 (39,29%) observamos anomalias urologicas asociadas, el reflujo vesicoureteral la mas frecuente (8 [14,29%]). Siete pacientes (12,5%) han desarrollado insuficiencia renal, y 49 pacientes (87,5%) desarrollaron hipertrofia renal contralateral compensatoria. De los 33 pacientes que se intervinieron el resultado de anatomia patologica confirmo el diagnostico de DRMQ en 32. En comparacion con la gammagrafia el VPP de la ecografia fue del 100% y del 97% al compararla con la anatomia patologica. La tasa de involucion espontanea fue del 5,4% a los 3 meses de vida, del 11,3% a los 2 anos y del 38,4% a los 5 anos. Conclusiones En nuestra experiencia el tratamiento conservador de la DRMQ, hasta al menos los 5 anos de edad, es seguro. Nuestros datos sugieren que la realizacion de la gammagrafia no es precisa en estos pacientes, lo que supone una menor exposicion a la radiacion, asi como un ahorro economico.

To analyze if there is a higher prevalence of sleep disturbances and hygiene disorders in patients with monosymptomatic enuresis (MEN) with respect to general population and to patients with corrected MEN. Assess the usefulness of the BEARS sleep disorder screening tool for children with MEN.Transverse observational study (n=341) classified as: MEN (n=122), corrected MEN (≥ 1 one year without recurrence) (ANTENUR) (n=47) and controls (n=172). The BEARS childhood sleep disorder screening questionnaire was used. Clinical variables were collected, as well as variables related to sleep hygiene.Chi-square, Student's t, ANOVA, Mann-Whitney U and Kruskal-Wallis. Significance p.05.Mean age 9.7±3.0 years. There were no statistically significant differences in terms of age, sex, BMI, history of tonsillectomy, asthma and sleep time hours. With respect to sleep hygiene, patients with MEN presented a higher percentage of alterations than controls. As for the BEARS questionnaire, it showed a higher prevalence of sleep disorders in the group of patients with MEN, with respect to the other two groups: 60.7% (n=74) versus 18.6% (n=32) and 38.3% (n=18) of controls and ANTENUR, respectively (p.05).Children with MEN had a higher prevalence of sleep disturbances and sleep disorders than controls. The BEARS questionnaire is a useful clinical tool in the detection of sleep disorders in children.

To determine the usefulnessof voiding diary (VD), uroflowmetry with electromyography(UF-EMG), bladder wall thickness (before micturition)(VWTUS) and residual urine (PVR) (ultrasound measure)in predicting the outcome of the first endoscopic treatment(1ENDT) of vesicoureteral reflux (VUR) in children3 years.Cross-sectional ambispective study of 48children with vesicoureteral reflux. Those with previousendoscopic treatment, age or neurological abnormalities and a history of urethralor abdominal surgery were excluded. The outcomevariable was the correctness (by isotopic cystography)three months after 1ENDT. Univariate and multivariateanalyses were performed through a Multilayer Perceptronnetwork and a logistic regression model EmpiricalBayesian penalized type LASSO Elastic net. Diagnosticaccuracy were determined.Mean age of the sample was 6.8 +/- 2.28years. The rate of VUR correction after 1ENDT was 77%.The variables selected by both methods were: VD-retentionist(OR 3.90), high PVR (OR 2.69), high VWTUS (OR4.44). Normal UF-EMG was a preventive variable (OR0.38). Diagnostic accuracy (pSp=48.7%), UF+EMG (Se=27.3%(Se=72.7% (AUC=0.8 cut point 20 ml),VWTUS (Se=81.8% (AUC=0.8 cut point4.6 mm). There were no statistical differences betweenPVR and VWTUS. Combined use of UF+EMG+PVR(Se=90.9%in predicting the persistence of VUR after 1ENDT inchildren3 years. After screening with a VD, UF-EMG+ RPM combination could be useful to detect these patientsand propose a treatment that improves bladdervoiding function prior to surgery.Determinar la utilidad deldiario miccional (DIM), la flujometría asociada a laelectromiografía (UF-EMG) y los parámetros ecográficoscomo son el espesor de la pared vesical premiciconal(EPVECO) y el residuo postmiccional (RPM) en la prediccióndel resultado del primer tratamiento endoscópico(1TEND) del Reflujo Vesico-Ureteral (RVU) en niños3años.MATERIAL Y MÉTODOS: Estudio transversal ambispectivode 48 niños con RVU. Criterios de exclusión: 1TENDprevio, edad y cirugía uretral o abdominal previas. Variableresultado: corrección del RVU (cistografía isotópica realizadatres meses después del 1TEND). Se realizaronanálisis univariante y multivariante mediante una red perceptrón multicapa y un modelo de regresión logísticapenalizada tipo Empirical Bayesian LASSO Elastic net.Se consideraron significativas las variables elegidas porambos métodos estadísticos. Se estudió el rendimientodiagnóstico de las pruebas individuales y combinadas.Media de edad: 6,8 +/- 2,28 años.Tasa de corrección del RVU traspredictoras de la persistencia del RVU tras 1TENDseleccionadas por ambos métodos: DIM-hábito retencionista(OR 3,90), RPM elevado (OR 2,69), EPVECOaumentado (OR 4,44). La UF-EMG sin alteracionesen el trazado se comportó como variable preventiva(OR 0,38). Rendimiento diagnóstico (p(Se=98% (Se=27,3%RPM (Se=72,7% (AUC=0,8 punto decorte óptimo 20 ml), EPVECO (Se=81,8%(AUC=0,8 punto de corte óptimo 4,6 mm).No existierondiferencias entre el uso del RPM y el EPVECO(p0,05). Uso conjunto de UF-EMG+RPM (Se=90,9%Es=92%) (pCONCLUSIONES: El estudio funcional no invasivo dela fase de vaciado es útil en la predicción de la persistenciade RVU tras el 1TEND en niños3 años. Trasel cribado con un diario miccional, la UF-EMG+RPMpodrían ser útiles para detectar a estos pacientes y plantearun tratamiento que mejore el vaciado vesical previoa la cirugía.

The management of renal trauma has been changing in recent years so that nowadays, even in high grades, an initial conservative treatment is advocated. The aim of this work is to review the presentation, initial attitude and evolution of the renal traumas treated in our institution.Retrospective review of patients with renal trauma treated at our institution in the last 10 years. Epidemiological variables, production mechanism, pediatric trauma index (PTI), treatment and evolution were analyzed.We studied 26 patients, 18 men (69.3%). The most frequent mechanism was the direct hit in 11 patients (42.31%). The most frequently side affected was the right one in 14 patients (53.85%). The grade III traumatism according to American Association for the surgery of Trauma (AAST) was the most repeated, 11 patients (42.31%). Nine patients (44.55%) presented concomitant injuries in other solid organs. In 24 patients (92.30%) the initial treatment was conservative with supportive measures. One patient presented with hemodynamic instability and an urgent intervention was conducted, performing a supraselective embolization with immediate control of the active bleeding. In another patient, a double J catheter was placed due to disruption of the excretory tract. Of the patients treated conservatively initially, only one patient (4.1%) required secondary surgical maneuvers due to a complication.In patients with renal trauma, non-surgical treatment is safe and effective. In case of hemodynamic instability or complication, interventional radiological techniques have been demonstrated to be safe and effective in the pediatric population.El manejo del traumatismo renal ha ido variando en los últimos años de modo que en la actualidad, incluso en los grados altos, se aboga por un tratamiento inicial conservador. El objetivo de este trabajo es revisar la presentación, actitud inicial y evolución de los traumatismos renales atendidos en nuestra institución.Revisión retrospectiva de pacientes con traumatismo renal atendidos en los últimos 10 años. Se analizaron las variables epidemiológicas, mecanismo de producción, índice de trauma pediátrico (ITP), tratamiento y evolución.Se estudiaron 26 pacientes, 18 varones (69,23%). La causa más frecuente fue el golpe directo en 11 pacientes (42,31%). El lado más frecuentemente afectado fue el derecho en 14 pacientes (53,85%). El traumatismo grado III según la American Association for the Surgery of Trauma (AAST) fue el más común, 11 pacientes (42,31%). Nueve pacientes (44,55%) presentaron lesiones concomitantes en otros órganos sólidos. En 24 pacientes (92,30%) el tratamiento inicial fue conservador con medidas de soporte. Un paciente se presentó con inestabilidad hemodinámica y se intervino de forma urgente realizándose embolización supraselectiva con control inmediato del sangrado activo. En otro paciente se colocó un catéter doble J por disrupción de la vía excretora. De los pacientes tratados de manera conservadora inicialmente solo 1 paciente (4,1%) requirió maniobras quirúrgicas secundarias debido a una complicación.En pacientes con traumatismo renal el tratamiento no quirúrgico es seguro y eficaz. En caso de inestabilidad hemodinámica o complicación, las técnicas radiológicas intervencionistas han demostrado ser seguras y efectivas en la edad pediátrica.

The management of renal trauma has been changing in recent years so that nowadays, even in high grades, an initial conservative treatment is advocated. The aim of this work is to review the presentation, initial attitude and evolution of the renal traumas treated in our institution.

To assess the diagnostic performance of urinary dysfunction patterns associated with vesicoureteral reflux (VUR) in children over the age of 3 according to the result of the first endoscopic treatment (ENDT1), grouped into a classification designed by our group (CMD.URI-La Fe). Comparison with other current classifications such as that of Van Batavia et al. MATERIAL AND METHODS: Ambispective cross-cutting study of a sample of 50 children.previous ENDT, age ≤ 3 years, anatomical or neurological anomalies and a history of ureteral or abdominopelvic surgery. Prior to the ENDT1, a bladder voiding function assessment by uroflowmetry+electromyography (UF-EMG) and post-mictional residue (ultrasound). Other variables from the bladder diary, pre-mictional bladder wall thickness and other clinical variables. The correction of VUR was assessed by isotope cystography 3 months after the treatment. Urinary patterns were classified according to the significant variables (URI-La Fe), and the diagnostic performance of this classification was assessed, comparing it to the classification of patients as proposed by Van Batavia et al. RESULTS: Mean age: 6.8±2.28 years. Males/females (44%/56%). Grades of VUR (mild/moderate/severe). ENDT1 VUR correction rate: 77% (n=38). Diagnostic performance (Van Batavia; URI-La Fe): correct prediction (37.5%; 75%), sensitivity (32.4%; 87.8%), specificity (54.5%; 46.6%), positive predictive value (70.6; 78.3%) and negative predictive value (19.4%; 63.6%).Our results show the usefulness of the non-invasive test and the classification of urinary dysfunction in children aged over 3 years prior to the first endoscopic treatment of VUR.

Main objective: to perform a descriptive study of patients with nephroblastoma, diagnostic tests, medical and surgical treatment. Secondary objective: to evaluate the rate of relapse and 5-year survival and risk factors for relapse and death.Retrospective study of patients with nephroblastoma treated according to the protocol of the SIOP-2001. Demographic variables, comorbidities and associated syndromes were collected. Other data were tumor location, size, extent and stage. The relapse rate and the development of other secondary tumors as well as the long-term survival were also studied.We collected 33 patients with nephroblastoma. A biopsy was performed in 7 patients (21.2%). The Kaplan-Meir curve for event-free survival (tumor recurrence) was 84% with a 95% CI = [0.73-0.98] and the Kaplan-Meier overall survival curve was 0.93 95% CI [0.85-1]. Recurrence occurred in all patients before the first year.Nephroblastoma is a tumor with a favorable prognosis. The unfavorable histology as well as advanced stages are factors of a poor prognosis. The follow-up must be exhaustive during the first year after the diagnosis.Objetivo principal: realizar un estudio descriptivo de los pacientes con nefroblastoma, las pruebas diagnósticas, el tratamiento médico y la actitud quirúrgica. Objetivo secundario: valorar la tasa de recidiva y de supervivencia a 5 años y los factores de riesgo para la recidiva y el fallecimiento.Estudio retrospectivo de pacientes con nefroblastoma tratados según el protocolo de la SIOP-2001. Se recogieron las variables demográficas, comorbilidades y síndromes asociados. Otros datos fueron la localización del tumor, el tamaño, la extensión y el estadio. Se estudió también la tasa de recidiva y/o el desarrollo de otros tumores secundarios así como la supervivencia a largo plazo.Se recogieron 33 pacientes con nefroblastoma. En 7 pacientes (21,2%) se realizó una biopsia. La curva de Kaplan-Meir para la supervivencia libre de evento (recidiva tumoral) fue del 84% con un IC 95%= [0,73-0,98] y la curva de Kaplan-Meier de supervivencia global fue de 0,93 IC 95% [0,85-1]. La recidiva se produjo en todos los pacientes antes del primer año.El nefroblastoma es un tumor con buen pronóstico. La histología desfavorable así como estadios avanzados son factores de mal pronóstico. El seguimiento debe ser exhaustivo durante el primer año tras el diagnóstico.