RESUMEN
Laser acupuncture is a painless, non-invasive, and cost effective treatment for children with therapy resistant monosymptomatic nocturnal enuresis. This kind of acupuncture is an alternative treatment with positive results. Currently, we are treating 24 children (22 males, 2 females) out of a planned 200 children aged between 5 and 12 years. These patients have had a classic monosymptomatic nocturnal enuresis. Up to now, school medicine therapy has been unsuccessful. Over 3 months, we treated the children once a week with acupuncture, inserting at the following points: medial Ren 3, bilateral Ma 36, bilateral Mi 6, bilateral Bl 33, medial Ren 6, medial Ex B5.A better enuresis frequency was achieved in 21 out of the 24 children (87.5%). Before the end of the 12th treatment, six of the 24 children (25%) were completely dry and 16 (66.6%) had an enuresis frequency reduced by more than half after the 12th treatment.
Asunto(s)
Terapia por Acupuntura/métodos , Enuresis/terapia , Terapia por Láser , Puntos de Acupuntura , Niño , Preescolar , Enuresis/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Retratamiento , Resultado del TratamientoRESUMEN
In a prospective study, from September 2000 to September 2001, all ureteroscopies ( n=140) were performed under local and intravenous patient controlled analgesia using continuous infusion of remifentanil (Ultiva). The dosage of 0.15 micro g/kg/min was adapted to changing intraoperative pain (range 0.08-0.30 micro g/kg/min). Preoperative sedation with midazolam 2 mg was given 5 min prior to ureteroscopy. The efficacy of monitored anesthesia care ("Big MAC") was quantified by the patient using a visual analogue pain scale. A total of 97.1% (136/140) of the procedures were performed and finished under remifentanil. Only four male patients underwent conversion to general anesthesia due to insufficient analgesia. All but one patient would choose remifentanil again for first line anesthesia. Significant differences in pain scale values were noticed for male/female patients and ureteroscopies above/below the iliac vessel crossing. Side effects were rare being mainly hypoxic events (pO(2)<90% in 5.1%). Indication, intraoperative procedure, average surgery time (24 min), complications and primary success rate (96.6/90/63.3% stone free for distal/mid/proximal ureter, respectively) did not differ from the control group under general anesthesia. Ureteroscopies with remifentanil are safe, universally applicable because of refifentanil's organ independent esterase metabolism and as effective as general anesthesia. There is no need for PACU stay for patients due to the ultra-short drug half-life, and therefore remifentanil is cost effective and perfect in an outpatient setting.
Asunto(s)
Carcinoma de Células Renales/terapia , Sedación Consciente , Cálculos Renales/terapia , Neoplasias Renales/terapia , Cálculos Ureterales/terapia , Obstrucción Ureteral/terapia , Ureteroscopía , Carcinoma de Células Renales/diagnóstico , Diagnóstico Diferencial , Relación Dosis-Respuesta a Droga , Eficiencia , Femenino , Humanos , Infusiones Intravenosas , Cálculos Renales/diagnóstico , Neoplasias Renales/diagnóstico , Masculino , Midazolam/administración & dosificación , Dimensión del Dolor , Satisfacción del Paciente , Piperidinas/administración & dosificación , Remifentanilo , Estudios Retrospectivos , Cálculos Ureterales/diagnóstico , Obstrucción Ureteral/diagnósticoRESUMEN
Acute urinary retention in children may be associated with a broad spectrum of different causes. Acute appendicitis or acute ovarian torsion are rare and complicate the diagnosis. The case of a 6-year-old girl with urinary retention caused by ovarian torsion is reported, in which clinical presentation showed nonspecific complaints and ultrasound demonstrated a retrovesical mass. The long-standing ovarian torsion could only be diagnosed by laparotomy. This case once again demonstrates possible difficulties in obtaining a correct diagnosis, especially when imaging techniques reach their limits. Here, the anatomical structures had become so altered by adhesions of the omentum that they were no longer identifiable, rendering the advantageous, non-invasive laparoscopy ineffective. As a result, laparotomy became the most accurate and reliable method for obtaining a correct diagnosis. The occurrence of acute urinary retention with ovarian torsion can be explained by an earlier disturbance of the vegetative nervous system.
Asunto(s)
Enfermedades del Ovario/complicaciones , Enfermedades del Ovario/diagnóstico , Retención Urinaria/etiología , Enfermedad Aguda , Factores de Edad , Niño , Femenino , Humanos , Laparoscopía , Laparotomía , Enfermedades del Ovario/cirugía , Anomalía TorsionalRESUMEN
PURPOSE: We evaluated the results and complications of children with reflux treated with the Politano-Leadbetter ureteroneocystostomy. In particular, we evaluated pre- and postoperative renal parenchymal scarring and the late development of hypertension. MATERIALS AND METHODS: From 1965 through 1996, 666 children (814 renal units) were reimplanted by nine urologists. The average postoperative evaluation was 10.3 years, and 68.8% of all patiens were evaluable 10 years after surgery. RESULTS: Postoperative complications occurred in 7.8% and consisted of small bowel serosal injury (0.3%), vesicocutaneous fistula (0.4%) and retrovesical hematoma (0.3%). Persistent reflux was the most common postoperative complication (5.6%) and was found to occur in higher grades of vesicorenal reflux. Ureteral stricture and hydronephrosis were seen in 1.2% of children, and was corrected with a secondary reimplantation. Late stricture occurred in all but 1 patient (0.2%). Renal parenchymal scarring was found in 21.2% of patients preoperatively, and this increased over time postoperatively to 27.7%. In 8.7% of these patients, hypertension developed between the 6th and 17th postoperative year. In 6.1%, nephrectomy was carried out, which normalized blood pressures in 87. 9% of these 30 patients. CONCLUSIONS: The Politano-Leadbetter ureteroneocystostomy was successful in 93.6% of all 814 renal units surgically treated. The operation is safe, but can be associated with late development of hypertension despite correction of the reflux.
Asunto(s)
Cistostomía , Ureterostomía , Reflujo Vesicoureteral/cirugía , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , MasculinoRESUMEN
PURPOSE: Prepubic urethrectomy is a simple, safe alternative to perineal urethrectomy. The lithotomy position can be avoided and, thus, operative time and risk of deep venous thrombosis are decreased. We developed a simple modification because of difficulty in dissecting the bulbous urethra. MATERIALS AND METHODS: From 1996 through 1998 prepubic urethrectomy was performed using a modified procedure in 21 patients with invasive bladder carcinoma undergoing radical cystectomy and supravesical diversion. After periurethral mobilization the urethra was cannulated with an 18F catheter, sutured distal and stripped free. RESULTS: Operative time decreased to 20 to 30 minutes with no significant postoperative complications. CONCLUSIONS: Our modification of prepubic urethrectomy is safe, fast and easy.