ABSTRACT Introduction: Defective closure of the neural tube affects different systems and generates sequelae, such as neurogenic bladder (NB). Myelomeningocele (MMC) represents the most frequent and most severe cause of NB in children. Damage of the renal parenchyma in children with NB acquired in postnatal stages is preventable given adequate evaluation, follow-up and proactive management. The aim of this document is to update issues on medical management of neurogenic bladder in children. Materials and Methods: Five Pediatric Urologists joined a group of experts and reviewed all important issues on “Spina Bifida, Neurogenic Bladder in Children” and elaborated a draft of the document. All the members of the group focused on the same system of classification of the levels of evidence (GRADE system) in order to assess the literature and the recommendations. During the year 2020 the panel of experts has met virtually to review, discuss and write a consensus document. Results and Discussion: The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies. Clean intermittent catheterization (CIC) should be implemented during the first days of life, and antimuscarinic drugs should be indicated upon results of urodynamic studies. When the patient becomes refractory to first-line therapy, receptor-selective pharmacotherapy is available nowadays, which leads to a reduction in reconstructive procedures, such as augmentation cystoplasty.

Objectives: To compare three different surgical approaches for the performance of varicocelectomy in the pediatric population, analyzing their effectiveness and secondary complications. Methods: Over an eight year period 90 varicocelectomies were performed in 89 children with a mean age of 12 years (range 8-16). Patients were divided into three groups, in 21 cases laparoscopic approach was performed (Group 1), in 55 the Palomo's retroperitoneal approach (Group 2) and inguinal approach in 14 cases (Group 3). Preoperative demographic characteristics, and intraoperative data, follow-up and complications were analyzed. Results: Age, indication and follow-up time were similar in all three groups. Average surgical time were 36 minutes,34 minutes and 30 minutes respectively. Recurrences appeared in one (4%), 5 (9%) and 0 patients respectively. Postoperative hydrocele requiring surgical treatment appeared in 2 (9%), 4 (7%) and 0 respectively, with an incidence of hydrocele of 2 cases (9%), 5 (9%) and 1 (7%) which resolved during follow-up. One patient presented bleeding at the site of trocar insertion which was solved intraoperatively, and another patient in the laparoscopy group had a wound infection. Conclusions: Comparisons between the three groups reveal that there were not significant differences, although the results were somewhat better in the inguinal approach group. Any technique has adequate results, with a total recurrence rate in our series of 6%, and 6% of hydroceles. The development of methods that will make possible to diminish hydrocele, such as lymphatic preservation, will give better general results.

Objetivo: Comparar tres diferentes abordajes para la realización de varicocelectomia en la población pediátrica, analizando su efectividad y complicaciones secundarias. Métodos: En 8 años 90 varicocelectomias fueron realizadas en 89 niños con una media de edad de 12 años (Rango 8-16). Los pacientes se dividieron en 3 grupos, en 21 casos se realizo laparoscópico (Grupo 1), en 55 abordaje retroperitoneal de palomo (Grupo 2) y en 14 casos abordaje inguinal (grupo 3). Se analizaron características demográficas prequirúrgicas, datos intraoperatorios, seguimiento y complicaciones. Resultados: La edad, la indicación y el tiempo de seguimiento fueron similares en los tres grupos. El tiempo quirúrgico fue en promedio de 36min, 34min y 30min en cada uno de los grupos. Recurrencias se presentaron en 1(4%), 5(9%) y 0 respectivamente. Hidrocele postoperatorio que requirió manejo quirúrgico se presento en 2(9%), 4(7%), 0 respectivamente y en 2(9%), 5(9%), 1(7%) se presentaron hidroceles en cada grupo los cuales resolvieron con el tiempo de seguimiento. Se presento en un paciente sangrado del sitio de inserción del trocar el cual se resolvió intraoperatoriamente y en un caso infección de herida quirúrgica en el grupo de laparoscopia. Conclusiones: La comparación de los tres grupos revela que no se presentaron diferencias significativas aunque se presentaron algunos resultados mejores con el inguinal. Cualquier técnica realizada provee resultados adecuados y en nuestra serie se presento recurrencia total del 6% e hidrocele del 6%. El desarrollo de métodos que permitan disminuir el hidrocele como la preservación linfática podrá dar mejores resultados generales.

Objectives: Classically, the diagnosis of ectopic ureter was done in grown up girls due to urinary incontinence, today the diagnoses are more precocious, which has partially changed treatment. The objective of this paper is to perform a review of our experience over the last years and to correlate it with the current type of presentation. Methods: We studied all patients with the diagnosis of ectopic ureter in a period of 10 years, between 1997 and December 2006. Demographic characteristics, type of presentation, diagnostic tests performed, age at the time of diagnosis and treatment were all analyzed, altogether with the different techniques employed for treatment. Results: We found 19 patients with this disease, 15 of them females. Type of presentation was febrile urinary tract infection in 13 patients, urinary incontinence in two, and prenatal diagnosis of hydronephrosis in 4. Sixteen children had double pyeloureteral systems and only three had single systems. In all cases the diagnosis was performed with renal-bladder ultrasound, urethrocystogram and endoscopic studies. Additional studies such as excretion pyelograms were performed in 8 patients at the start of the series and nuclear medicine tests in 17. Median age at the time of diagnosis was eight months. All patients underwent surgical treatment. In patients with double systems superior heminephroureterectomy wae performed in 8 patients, vesicoureteral reimplantation in three and pyelo-pyelic anastomosis in three cases with upper pole remnant function. In another two cases nephroureterectomy was performed due to the presence of reflux to the lower or system and severe renal compromise. In all three cases with single systems ureter reimplantation was performed. Conclusions: Currently prenatal suspicion and adequate study of urinary tract infections enable confirmation of ectopic ureter. Few children debut with urinary incontinence currently, due to the precocity of diagnosis. Treatment is always surgical, and basically depends on renal function, and the presence or absence of vesicoureteral reflux. Vesicoureteral reimplantation is performed preferentially in patients with ectopic ureter and a single system, and superior heminephrectomy in those with double systems, leaving the distal ureter of first option.

Objetivo: Clásicamente el diagnóstico de uréter ectópico se hacía en niñas mayores por incontinencia urinaria, hoy los diagnósticos son más precoces, lo que ha cambiado parcialmente su tratamiento. El objetivo del presente trabajo es realizar una revisión de nuestra experiencia en los últimos años y correlacionar con la forma de presentación en la actualidad. Métodos: Se estudiaron todos los pacientes con diagnóstico de uréter ectópico en un periodo de 10 años, entre enero de 1997 y diciembre de 2006. Se analizaron las características demográficas, la forma de presentación, estudios realizados, edad al diagnóstico y tratamiento, junto a las distintas técnicas empleadas para solucionar su patología. Resultados: Se encontraron 19 pacientes con esta patología, 15 de sexo femenino. La forma de presentación estuvo dada en 13 pacientes con infección urinaria febril, 2 con incontinencia urinaria y en 4 el diagnóstico fue prenatal por hidronefrosis. Doble sistema pielo ureteral tenían 16 niños y solo 3 tenían sistema único. El diagnóstico en todos los casos se realizo con ecografía renal y vesical, uretrocistografía y estudios endoscópicos. Estudios adicionales como pielografía de eliminación se realizo en 8 al comienzo de la serie, y estudios de medicina nuclear en 17. La mediana de edad al momento del diagnóstico fue de 8 meses. El tratamiento fue quirúrgico en todos. En los dobles sistemas se realizó heminefroureterectomía superior en 8 pacientes, reimplante vésicoureteral en 3 y píelo-pieloanastomosis en 3 casos con función remanente del polo renal superior. En otros 2 casos se realizó nefroureterectomía por presencia de reflujo al sistema inferior y compromiso renal severo. En los sistemas únicos se realizó reimplante en los 3 casos. Conclusiones: La sospecha prenatal y el estudio adecuado de las infecciones del tracto urinario permite confirmar el diagnóstico de uréter ectópico. Pocos niños debutan con incontinencia urinaria en la actualidad, debido a lo precoz del diagnóstico. El tratamiento es siempre quirúrgico, y depende básicamente de la función renal, y la presencia o no de relujo vésico ureteral. De preferencia en los pacientes con uréter ectópico en sistema único se realiza un reimplante vésicoureteral y en los con doble sistema una heminefrectomía superior, abandonando el uréter distal en una primera instancia.