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Objetivos. Describir nuestra experiencia en tumores testiculares y paratesticulares en la etapa prepuberal, incidiendo sobre todo en su carácter de benignidad/malignidad y el tratamiento quirúrgico empleado. Material y Métodos. Revisión retrospectiva de todos los tumores testiculares en menores de 12 años, diagnosticados y tratados en nuestro ámbito clínico desde 1998 hasta 2015. Se recogieron datos sobre su forma de presentación, estudio y manejo. Resultados. 17 niños con tumores testiculares prepuberales fueron identificados. La presentación clínica como masa palpable testicular se dio en 12 casos (70,5%). De los niveles de marcadores tumorales (alfa-fetoproteína y βhCG), solo estuvo aumentada la alfa-fetoproteína en dos casos. En el estudio anatomopatológico, el 64,7% de los tumores fueron benignos (cinco teratomas maduros, cuatro tumores de células de Leydig, un teratoma inmaduro y un tumor de los cordones sexuales-estromal). Los tumores malignos fueron tres rabdomiosarcomas (17,6%), dos tumores del saco vitelino (11,8%) y un linfoma de Burkitt (5,9%). La edad media de los benignos fue 5,9 años y de los malignos 2,9 años, (p=0,68). De las lesiones neoplásicas nueve fueron de estirpe no germinal (53%) y ocho germinales (47%). En el manejo quirúrgico se realizó tumorectomía en seis tumores benignos, orquidectomía en cinco tumores benignos y en todos los tumores malignos salvo el linfoma que sólo recibió quimioterapia. Conclusiones. Los tumores testiculares y paratesticulares primarios benignos son más frecuentes en la etapa prepuberal y en su tratamiento se acepta indicar cirugía conservadora por vía inguinal

Objectives. To describe our experience in testicular and paratesticular tumors during the prepubertal stage, focusing especially on its character of benignity/malignancy and surgical treatment used. Material and Methods. Retrospective review of all testicular tumors in children under 12 years diagnosed and treated in our clinical setting from 1998-2015. Data on their presentation, study and management were collected. Results. 17 children with prepubertal testicular tumors were identified. The clinical presentation as palpable testicular mass occurred in 12 cases (70.5%). Levels of tumor markers (alpha-fetoprotein and βhCG) were only increased alpha-fetoprotein in two cases. In the histopathological study, 64.7% of the tumors were benign (five mature teratomas, four Leydig cells tumors, one immature teratoma and one sexual cords-stromal tumor). Malignant tumors were three rhabdomyosarcoma (17.6%), two yolk-sac tumors (11.8%) and one Burkitt lymphoma (5.9%). The mean age of benign was 5.9 years old and malignant 2.9 years old (p=0.68). From neoplastic lesions nine were non-germline (53%) and eight germline (47%). In the management testis-sparing surgery was performed in six benign tumors, and orchiectomy in five benign tumors and in all malignant tumors except lymphoma which received chemotherapy. Conclusions. Benign primary testicular and paratesticular tumors are more frequent in prepubertals and testis-sparing surgery is indicated by inguinal approach

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Introducción. Hay pocos estudios sobre la evolución postquirúrgica a largo plazo de la estenosis de la unión pieloureteral (EUPU). ¿Existe una dilatación residual en todos los pacientes que presentan resultados satisfactorios tras la cirugía? ¿Cuál es la evolución en los parámetros ecográficos? Pacientes y Métodos. Revisión retrospectiva de pacientes con EUPU intrínseca, con diámetro anteroposterior (AP) de la pelvis > 15 mm (e hidronefrosis grado III o superior), y seguidos tras pieloplastia de Anderson-Hynes en el periodo 2001-2010 (10 años), no reintervenidos, asintomáticos y con función renal normal. Los controles ecográficos se hicieron a los 3 y 6 meses postoperatorio (PO) y posteriormente anuales. Se midieron tres parámetros: diámetro AP, ratio pelvis/córtex (R P/C) y porcentaje de mejoría (PM) Resultados. Se seleccionaron 41 pacientes, intervenidos entre 2 meses y 10,3 años (media 13 meses, 83% en primer año de vida), mediana de seguimiento: 4 años (rango: 1-12). El diámetro AP de la pelvis renal medio pre-quirúrgico fue de 25 mm (rango 16-54). A los 3 meses la disminución media del diámetro AP (o PM) fue del 28% (respecto a diámetro prequirúrgico). A los 6 meses PO, fue del 51%, permaneciendo estable durante los siguientes años: 50%, 57%, 60%, 51%, 39%, 46%, 38%, 42% (controles anuales durante los primeros 8 años). La relación pelvis/córtex disminuyó de manera significativa ya en las ecografías al tercer mes (4,6 vs. 1,8; p= 0,03). En 8 pacientes (19,5%) se pudo objetivar ausencia de dilatación piélica en la evolución. Conclusiones. Aunque los cambios ecográficos tras la pieloplastia se pudieron objetivar desde los controles precoces, permanecieron a menudo sin cambios durante los controles posteriores. Sin embargo, en uno de cada cinco pacientes se objetivó la desaparición de la dilatación piélica

Introduction. There are few studies on the long term follow up of pyeloplasty. Is there a residual pelvis dilatation in all successful procedures? How is the long term evolution of the ecographic parameters and measures postoperatively (PO)? Patients and Methods. We reviewed all successful AndersonHynes pyeloplasties performed on obstructed renal pelvis with an anterio-posterior diameter > 15 mm during 2001-2010. Ultrasound controls were made at 3 and 6 months postoperatively and then yearly afterwards. We aimed to describe time course of hydronephrotic changes following unilateral pyeloplasties, using three parameters: pelvic anterior-posterior diameter (APD), pelvis/córtex ratio (P/C R) and the percentage of improvement in APD (PI-APD) Results. 41 patients were included. Age at intervention ranged from 2 months to 10.3 years (mean 13 months, 83% were operated in the first year of life). Median of follow up was 4 years (range 1-12 years). Mean APD preoperatively was 25 mm (range 16-54). At the third month PO, PI-APD was 28%. At the sixth month control, it was 51%, and remained stable during the next consecutive yearly controls, without statistically significant variations (50%, 57%, 60%, 51%, 39%, 46%, 38%, 42%). P/C R diminished significantly already in the third month control (4.6 vs. 1.8, p = 0.03). We observed complete disappearance of hidronephrosis in 8 patients (19.5%). Discussion. Although early postoperative ultrasound changes occur, the ultrasound parameters remain often stable during long term follow up. We documented the complete normalization of renal pelvis (no hydronephrosis) in one of every five patients

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INTRODUCTION: There are few studies on the long term follow up of pyeloplasty. Is there a residual pelvis dilatation in all successful procedures? How is the long term evolution of the ecographic parameters and measures postoperatively (PO)? PATIENTS AND METHODS: We reviewed all successful Anderson-Hynes pyeloplasties performed on obstructed renal pelvis with an anterio-posterior diameter >15 mm during 2001-2010. Ultrasound controls were made at 3 and 6 months postoperatively and then yearly afterwards. We aimed to describe time course of hydronephrotic changes following unilateral pyeloplasties, using three parameters: pelvic anterior-posterior diameter (APD), pelvis/córtex ratio (P/C R) and the percentage of improvement in APD (PI-APD). RESULTS: 41 patientswereincluded. Age at intervention ranged from 2 months to 10.3 years (mean 13 months, 83% were operated in the first year of life). Median of follow up was 4 years (range 1-12 years). Mean APD preoperatively was 25 mm (range 16-54). At the third month PO, PI-APD was 28%. At the sixth month control, it was 51%, and remained stable during the next consecutive yearly controls, without statistically significant variations (50%, 57%, 60%, 51%, 39%, 46%, 38%, 42%). P/C R diminished significantly already in the third month control (4.6 vs. 1.8, p=0.03). We observed complete disappearance of hidronephrosis in 8 patients (19.5%). DISCUSSION: Although early postoperative ultrasound changes occur, the ultrasound parameters remain often stable during long term follow up. We documented the complete normalization of renal pelvis (no hydronephrosis) in one of every five patients.

INTRODUCCION: Hay pocos estudios sobre la evolución postquirúrgica a largo plazo de la estenosis de la unión pieloureteral (EUPU). ¿Existe una dilatación residual en todos los pacientes que presentan resultados satisfactorios tras la cirugía? ¿Cuál es la evolución en los parámetros ecográficos? PACIENTES Y METODOS: Revisión retrospectiva de pacientes con EUPU intrínseca, con diámetro anteroposterior (AP) de la pelvis >15 mm (e hidronefrosis grado III o superior), y seguidos tras pieloplastia de Anderson-Hynes en el periodo 2001-2010 (10 años), no reintervenidos, asintomáticos y con función renal normal. Los controles ecográficos se hicieron a los 3 y 6 meses postoperatorio (PO) y posteriormente anuales. Se midieron tres parámetros: diámetro AP, ratio pelvis/córtex (R P/C) y porcentaje de mejoría (PM). RESULTADOS: Se seleccionaron 41 pacientes, intervenidos entre 2 meses y 10,3 años (media 13 meses, 83% en primer año de vida), mediana de seguimiento: 4 años (rango: 1-12). El diámetro AP de la pelvis renal medio pre-quirúrgico fue de 25 mm (rango 16-54). A los 3 meses la disminución media del diámetro AP (o PM) fue del 28% (respecto a diámetro prequirúrgico). A los 6 meses PO, fue del 51%, permaneciendo estable durante los siguientes años: 50%, 57%, 60%, 51%, 39%, 46%, 38%, 42% (controles anuales durante los primeros 8 años). La relación pelvis/córtex disminuyó de manera significativa ya en las ecografías al tercer mes (4,6 vs. 1,8; p= 0,03). En 8 pacientes (19,5%) se pudo objetivar ausencia de dilatación piélica en la evolución. CONCLUSIONES: Aunque los cambios ecográficos tras la pieloplastia se pudieron objetivar desde los controles precoces, permanecieron a menudo sin cambios durante los controles posteriores. Sin embargo, en uno de cada cinco pacientes se objetivó la desaparición de la dilatación piélica.

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OBJECTIVES: To describe our experience in testicular and paratesticular tumors during the prepubertal stage, focusing especially on its character of benignity/malignancy and surgical treatment used. MATERIAL AND METHODS: Retrospective review of all testicular tumors in children under 12 years diagnosed and treated in our clinical setting from 1998-2015. Data on their presentation, study and management were collected. RESULTS: 17 children with prepubertal testicular tumors were identified. The clinical presentation as palpable testicular mass occurred in 12 cases (70.5%). Levels of tumor markers (alpha-fetoprotein and ßhCG) were only increased alpha-fetoprotein in two cases. In the histopathological study, 64.7% of the tumors were benign (five mature teratomas, four Leydig cells tumors, one immature teratoma and one sexual cords-stromal tumor). Malignant tumors were three rhabdomyosarcoma (17.6%), two yolk-sac tumors (11.8%) and one Burkitt lymphoma (5.9%). The mean age of benign was 5.9 years old and malignant 2.9 years old (p=0.68). From neoplastic lesions nine were non-germline (53%) and eight germline (47%). In the management testis-sparing surgery was performed in six benign tumors, and orchiectomy in five benign tumors and in all malignant tumors except lymphoma which received chemotherapy. CONCLUSIONS: Benign primary testicular and paratesticular tumors are more frequent in prepubertals and testis-sparing surgery is indicated by inguinal approach.

OBJETIVOS: Describir nuestra experiencia en tumores testiculares y paratesticulares en la etapa prepuberal, incidiendo sobre todo en su carácter de benignidad/malignidad y el tratamiento quirúrgico empleado. MATERIAL Y METODOS: Revisión retrospectiva de todos los tumores testiculares en menores de 12 años, diagnosticados y tratados en nuestro ámbito clínico desde 1998 hasta 2015. Se recogieron datos sobre su forma de presentación, estudio y manejo. RESULTADOS: 17 niños con tumores testiculares prepuberales fueron identificados. La presentación clínica como masa palpable testicular se dio en 12 casos (70,5%). De los niveles de marcadores tumorales (alfa-fetoproteína y ßhCG), solo estuvo aumentada la alfa-fetoproteína en dos casos. En el estudio anatomopatológico, el 64,7% de los tumores fueron benignos (cinco teratomas maduros, cuatro tumores de células de Leydig, un teratoma inmaduro y un tumor de los cordones sexuales-estromal). Los tumores malignos fueron tres rabdomiosarcomas (17,6%), dos tumores del saco vitelino (11,8%) y un linfoma de Burkitt (5,9%). La edad media de los benignos fue 5,9 años y de los malignos 2,9 años, (p=0,68). De las lesiones neoplásicas nueve fueron de estirpe no germinal (53%) y ocho germinales (47%). En el manejo quirúrgico se realizó tumorectomía en seis tumores benignos, orquidectomía en cinco tumores benignos y en todos los tumores malignos salvo el linfoma que sólo recibió quimioterapia. CONCLUSIONES: Los tumores testiculares y paratesticulares primarios benignos son más frecuentes en la etapa prepuberal y en su tratamiento se acepta indicar cirugía conservadora por vía inguinal.

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Las valvas ureterales son malformaciones muy poco frecuentes, con una incidencia de uno de cada 5.000-8.000 nacidos vivos. Las malformaciones relacionadas con la esfera urológica se asocian en un 50% de los casos según la literatura actual. Presentamos 4 casos tratados en nuestro centro desde 2004 hasta 2012. El 75% de los casos presentaba disgenesia renal con función anulada, en un caso se asociaba a sistema ureteral doble completo y en otro a una atresia ureteral

Ureteral valves are a rare malformation, with an incidence of 1 in 5000-8000 live births. Urological malformations are associated with 50% of cases according to the current literature. We report 4 cases treated in our hospital from 2004 to 2012. Three of the patients had renal dysgenesis, one case associated with complete urethral duplication, and another case associated with a ureteral atresia

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Ureteral valves are a rare malformation, with an incidence of 1 in 5000-8000 live births. Urological malformations are associated with 50% of cases according to the current literature. We report 4 cases treated in our hospital from 2004 to 2012. Three of the patients had renal dysgenesis, one case associated with complete urethral duplication, and another case associated with a ureteral atresia.

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PURPOSE: The primary vesicoureteral reflux (PVUR) is the most common urologic pathology during childhood and affects from 1 to 3% of newborn. It causes acute pyelonephritis (APN) and renal damage in addition to hospital visits with high economic and social costs. Nowadays the endoscopic treatment (ETR) seems to be the most suitable one for the reflux, due to its lower biological cost and its good results. We report our experience in the endoscopic treatment of the primary vesicoureteral reflux (ETR) in Murcia Pediatric Hospital from 1998 to 2007. PATIENTS AND METHODS: We present a retrospective study describing 989 patients (1498 ureters) treated by means of ETR. All patients were treated with chemoprophylaxis since the moment of the diagnosis. ETR was fulfilled by the surgeon in an ambulatory way and with Sevofluorano. Deflux, Macroplastique and Coaptite were used. Age, stade, number of ETR, material, chemoprophylaxis, ureterocistoneostomy and ETR costs were evaluated. RESULTS: One-thousand four-hundred and ninty-eight ureteral units, corresponding to 989 patients, (51,2% males), at ages from 4 months to 21-years-old, have been treated by means of ETR. The average age was 4-years-old. Grade III reflux was the most common of all, with 801 ureters affected. Deflux was used in 777 patients, Macroplastique in 203 and Coaptite in 9. No problems in early post-operation happened and the average length was shorter than 2 hours. Forty-eight hours after, 7 patients had to be treated due to APN. Four patients showed late litiasis related to ETR. Two suffered litotomy. The 89.9% of the patients were cured at first ETR. The 11.2% needed a second ETR, with 2.12% of failure (21 patients). Six cured with the third injection and 2 needed a fourth ETR. Thirteen children were treated with ureterocistoneostomy. Radiological correction have not relation with PVUR level and does not show significant differences. Failure regarding the used material was around 9% for Deflux, 11.8% for Macroplastique and 66.6% for Coaptite. The cost of ETR was 1.400 euros, the cost of ureterocistoneostomy 4.822 euros and of the chemoprophylaxis 4.158,7 euros per year. CONCLUSIONS: From our experience, ETR is a method as safe as surgery and with less morbility. It is, furthermore, much more predictable than chemoprophylaxis and implies lower economical, biological and social costs than those other methods. In case of failure, ETR does not prevent any other kind of treatment. We regard ETR as a first order therapeutic gesture when dealing with PVUR.

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Objetivo: El reflujo vesicoureteral primario (RVUP) es la uropatíamas frecuente en la infancia y afecta entre el 1 y el 3% de los recién nacidos. Es responsable de episodios de pielonefritis aguda (PNA) que pueden producir daño renal además de consultas e ingresos hospitalarios que generan altos costes económicos y sociales. En la actualidad, el tratamiento endoscópico del reflujo (TER) parece ser la opción más adecuada, de entrada, por su menor coste biológico y resultados. El objetivo de nuestro trabajo es comunicar nuestra experiencia en el tratamiento endoscópico del RVUP en un hospital de referencia en la Comunidad Autónoma de Murcia entre los años 1.998y 2007.Pacientes y métodos: Presentamos un estudio retrospectivo descriptivo de 989 pacientes (1.498 uréteres) afectados de RVUP tratados mediante TER. Todos los pacientes fueron sometidos a quimioprofilaxis desde el diagnóstico. El TER se realizó de forma ambulatoria y bajo sedación anestésica con Sevofluorano. Hemos empleado Deflux®,Macroplástico® y Coaptite®. La quimioprofilaxis se suspendió después de comprobar mediante cistografía, a partir del mes del TER, la desaparición radiológica del reflujo. Evaluamos nuestros resultados en función de la edad, estadio, número de inyecciones y material utilizado, así como los costes de la quimioprofilaxis y la ureterocistoneostomía en comparación al TER y las complicaciones del mismo. Resultados: Hemos sometido a TER a 1.498 unidades ureterales correspondientes a 989 pacientes (51,2% varones) con edades comprendidas entre los 4 meses y los 21 años de edad. La edad media fue desde 4 años. El estadio III de reflujo fue el más numeroso con 801 uréteres afectados. Se empleó Deflux® en 777 pacientes. Macroplástico® en 203 y Coaptite® en 9. No tuvimos complicaciones en el postoperatorio inmediato y la estancia media no superó las dos horas. A las 48horas 7 pacientes ingresaron por PNA. Cuatro pacientes han presentado litiasis tardía que en 2 casos han necesitado litotomía. El 89,8 de los pacientes curaron al primer TER. El 11,2% necesitó un segundo TER, con un 2,12% de fracasos (21 pacientes) . Seis curaron a la tercera inyección y 2 necesitaron un cuarto TER. Trece niños fueron sometidos aureterocistoneostomía. La curación radiológica en relación al grado de RVUP no presentó diferencias significativas. Los fallos en función del material empleado fueron del 9% para Deflux®, 11,8% para Macroplástico® y 66,6% para Coaptite®. El coste del TER fue de 1.400 euros. De la ureterocistoneostomía 4.822 euros y de la quimioprofilaxis 4.158,7euros/año. Conclusiones: En nuestra experiencia el TER es un procedimiento tan seguro como la cirugía y con menos morbilidad que ésta. Es, además mucho más predecible que la quimioprofilaxis y conlleva menores costes económicos, biológicos y sociales que estos dos y, en caso de fallo, no impide ningún otro tipo de tratamiento, por lo que lo consideramos un gesto terapéutico de primer orden en el manejo del RVUP (AU)

Purpose. The primary vesicoureteral reflux (PVUR) is the most common urologic pathology during childhood and affects from 1 to 3%of new born . It causes acute pyelonephritis (APN) and renal damage in addition to hospital visits with high economic and social costs. Nowadays the endoscopic treatment (ETR) seems to be the most suitable one for the reflux, due to its lower biological cost and its good results. We report our experience in the endoscopic treatment of the primary vesicoureteralreflux (ETR) in Murcia Pediatric Hospital from 1998 to 2007.Patients and methods. We present a retrospective study describing989 patients (1498 ureters) treated by means of ETR. All patients were treated with chemoprophylaxis since the moment of the diagnosis. ETR was fulfilled by the surgeon in an ambulatory way and with Sevofluorano. Deflux®, Macroplastique® and Coaptite® were used. Age, stade, number of ETR, material, chemoprophylaxis, ureterocistoneostomy and ETR costs were evaluated. Results: One-thousand four-hundred and ninty-eight ureteral units, corresponding to 989 patients, (51,2% males), at ages from 4 months to 21 years old, have been treated by means of ETR. The average age was 4 years old. Grade III reflux was the most common of all, with 801 ureters affected. Deflux® was used in 777patients, Macroplastique® in 203 and Coaptite® in 9. No problems in early post-operation happened and the average length was shorter than2 hours. Forty-eight hours after, 7 patients had to be treated due to APN. Four patients showed late litiasis related to ETR. Two suffered litotomy. The 89.9% of the patients were cured at first ETR. The 11.2% needed a second ETR, with 2.12% of failure (21 patients). Six cured with the third injection and 2 needed a fourth ETR. Thirteen children were treated with ureterocistoneostomy. Radiological correction have not relation with PVUR level and does not show significant differences. Failure regarding the used material was around 9% for Deflux®, 11.8%for Macroplastique® and 66.6% for Coaptite®. The cost of ETR was1.400 euros, the cost of ureterocistoneostomy 4.822 euros and of the chemoprophylaxis 4.158,7 euros per year. Conclusions: From our experience, ETR is a method as safe as surgery and with less morbility. It is, furthermore, much more predictable than chemoprophylaxis and implies lower economical, biological and social costs than those other methods. In case of failure, ETR does not prevent any other kind of treatment. We regard ETR as a first order therapeutic gesture when dealing with PVUR (AU)

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OBJECTIVES: To report a case of extrarenal Wilms' tumor, an uncommon site of presentation of this tumor type. The diagnostic and prognostic aspects of this condition are also discussed. METHODS/RESULTS: A case of retroperitoneal extrarenal Wilms' tumor in a 2-year-old child is presented. The patient underwent surgery and received postoperative chemotherapy. At 3-years' follow-up, no evidence of metastasis has been observed. CONCLUSIONS: Extrarenal Wilms' tumor is rare and has been reported in the literature principally as case reports. Its clinical presentation varies according to the extrarenal localization. The procedures utilized to determine the size of the primary tumor, regional node involvement and the presence of distant metastasis are similar to those utilized in Wilms' tumor of the kidney. Our results demonstrate the utility of chemotherapy; the cytostatic agents utilized appear to be as effective as in Wilms' tumor of the kidney. In our view, radiotherapy should be reserved for the large unresectable residual tumor mass and for distant metastasis.

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MRD is the most common form of renal cystic disease. It comprises severe dysplasia of the kidney, which adopts a non-reniform configuration, with the absence of a calyceal drainage system. Diagnosis is by ultrasound. Management of this non-functional mass has been traditionally surgical, although most recently a conservative approach with follow-up by periodical monitoring has been postulated by several schools.

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Four cases of gonadal tumors in infancy were treated in the Service of Pediatric Surgery of the Hospital Infantil "Virgen de la Arrixaca", Murcia, during the first two years of surgical work. One of them is a Leydig cells testicular tumor, the second is a ovary tumor of the granulosa and the last two cases were ovarian cysts, one of them associated with precocious puberty. The clinical features, diagnostic and therapeutic problems of these tumors are reviewed.

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