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Objective To evaluate the efficacy of a third endoscopic injection to correct vesicoureteral reflux (VUR). Patients and methods This was a prospective study of 605 patients, of whom 42 (6.4%), involving 44 (4%) ureteral units, received a third injection. The results were analysed regarding VUR grade and aetiology, substance used, volume, location and morphology of the mound, presence of poor prognostic factors, the urologist’s experience, and complications. Results The treatment resolved the VUR in 38 (86.4%) units, 22 of primary cause (91.6%) and 16 with anatomical/functional abnormalities (80%) (no significant difference; P = 0.26). There was also no significant difference in success rate with regard to the substance injected ( P = 0.23), the degree of VUR ( P = 0.76) or the volume injected ( P = 0.17). The success rate was higher (96.9%) if a less experienced urologist had performed the previous procedure versus a more experienced urologist (54.5%), and this difference was significant ( P Conclusion Third treatment presents a similar efficacy to first and second treatments, with a very low rate of complications, and could be indicated before open surgery.

Background A genetic tendency to develop latex IgE responses in children with spina bifida has been suggested, but their degree of exposure to latex as well as the route and chronology for sensitization can be different from those of other children with multiple surgeries. The aim was to study the influence of the type of operation on the development of latex sensitization in children with myelomeningocele. Methods In 90 children with myelomeningocele operated with latex, data were collected about age, sex, family, and personal history of allergy, serum total IgE, presence of a ventricular-peritoneal (v-p) shunt, and number and duration of operations, classified as urological, orthopedic, on the v-p shunt, other neurosurgical, and others. A multivariate logistic regression analysis was performed, using the presence of latex sensitization as dependent variable. Results Serum total IgE, the number of urological and of orthopedic operations were synergistic variables to predict latex sensitization, together with the presence of a v-p shunt, but not the number of operations performed on this device. This seems to play an adjuvant role in the process of sensitization. Conclusions Not only the number, but also the type of operations, namely, of urological and orthopedic nature, is important in the development of latex sensitization in children with myelomeningocele.

Over 6 years, the prevalence of latex sensitization fell from 4/15 (26.7%) to 1/22 (4.5%) in children with spina bifida treated in a latex-free environment from birth compared with historic controls. These precautions appear to be efficacious for the primary prevention of latex sensitization.

To report our experience with pediatric renal adenocarcinoma.

Objectives To report our experience with pediatric renal adenocarcinoma. Methods We conducted a retrospective review of renal adenocarcinoma cases from 1971 to 2006. Results We treated 154 patients with renal tumor, 4 (2.6%) of whom had adenocarcinoma. The mean age of presentation was 8.5 years (range, 2-15 years). Three patients were female and 1 was male. The most common histologic subtype was clear cell carcinoma. Three patients were diagnosed as stage IIIB and one as stage II, according to Robson's classification. All patients were treated with radical nephroureterectomy. One patient died of disease and the other 3 are currently disease-free. Conclusions Adenocarcinoma is an uncommon histopathologic type of pediatric renal tumor. In patients with hematuria and abdominal or flank pain, we should consider this tumor as a possible diagnosis.

The case is presented of a 10-year-old HIV+ male with renoureteral pain, who developed an obstructive uropathy with renal function impairment and required endoscopic placement of a ureteral stent. Certain aspects of the epidemiology, clinical presentation, diagnosis, treatment and prevention are discussed.

OBJECTIVE To create an artificial neural network (ANN) to aid in predicting the results of endoscopic treatment for vesico-ureteric reflux (VUR). MATERIALS AND METHODS During 1999–2001 we used endoscopic treatment in 261 ureteric units with VUR of all grades and causes. An ANN based on multilayer perceptron architecture was created using an 11 × 6 × 1 structure, taking the following as variables: the cause and grade of VUR, the patient's age and sex, the type of implanted substance and its volume, the number of treatments, the affected ureter, the endoscopic findings, and the type of cystography used. In all, 174 cases were used as training samples for the ANN and 87 to validate it. We calculated the sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and the success rate (%) of the system. RESULTS In the training group the ANN gave a sensitivity of 86.4%, a specificity of 89.5%, a PPV of 76% and NPV of 94%, with a success rate of 88.6%. In the same training group logistic regression (LR) gave respective values of 68.2%, 58.8%, 39%, 82.7% and 61.4%. In the validation group the respective values for the ANN were 71.4%, 81.6%, 58.8%, 88.6% and 78.9%, and in the same validation group the LR gave 64.4%, 50%, 32.1%, 79.2% and 53.9%. The Wilcoxon test confirmed the independence of both methods (P

Background Previous findings suggest that sensitization to latex in children with spina bifida is a dynamic process. Objective To study if changes appear in the sensitization status after withdrawal of latex. Methods We studied a consecutive sample of 68 children with spina bifida, by means of latex skin prick tests and quantification of serum latex-specific IgE on two separate occasions two years apart. Results Forty-four (65%) were classified as nonsensitized, 6 (9%) showed indeterminate results, and 18 (26%) were sensitized to latex, six of whom had clinical reactions to latex. They were instructed to avoid latex. In a second evaluation, 2 years later, 38 (56%) were classified as nonsensitized, 3 (4%) as indeterminate, and 27 (40%) as sensitized to latex, 11 of whom had presented latex symptoms. This meant 22% of spina bifida children demonstrated progressive sensitization, in spite of having adopted a latex-free environment at our hospital. It illustrates the progressive character of latex sensitization in these patients. Conclusion Latex avoidance measures both in the medical and home settings must be stressed. We recommend that children with spina bifida should be periodically evaluated regarding latex sensitization.

We present a case of transitional cell tumor of the urinary bladder in an 8-year-old boy and discuss certain aspects of the epidemiology, aetiology, prognosis, treatment and follow-up. We review the published cases in the literature since 1992, and compare them with the classic series.

We report a case of a 3-month-old boy with a megaprepuce presented since birth. Certain aspects of the aetiology, denomination, diagnosis and treatment are discussed. We compare our case with the three unique cases published in the literature.

Histological changes in the contralateral testis in 8 prepubertal children whose ages ranged from 3 to 7.5 years with a history of testicular torsion and subsequent atrophy were studied. The following histological parameters were evaluated: fertility tubular index (FTI), Sertoli cell index (SCI) and minimum tubular diameter (MTD). According to our findings and following Nistal and Paniagua's classification (1984) for tubular alterations, we found 5 cases (62.5%) who present the following alterations. Type 1 (case 2): FTI was decreased above 50% corresponding to slight germinal hypoplasia with normal MTD and SCI. Type 2 (cases 3 and 5): testis with remarkable germinal hypoplasia; FTI was between 30 and 50% while MTD was below normal values. Type 3 (case 8): testis with diffuse tubular hypoplasia; FTI was below 30%, whereas MTD showed 33% decrease regarding normal values. Type 4 (case 6): testes with hyperplasia of Sertoli cells; SCI was increased one third with regard to that corresponding to his age; FTI showed severe hypoplasia of germ cells. No relationship between alterations in either the age of the patients or the time elapsed since the torsion was observed. Because of all these facts and the young age of our patients, we believe that the alterations found in the contralateral testis were due to congenital dysgenesia.

We review 37 patients diagnosed of Wilms' tumor at the Clinica Infantil "La Fe", in the last ten years, looking at the misdiagnosed cases. In two children, histological study showed a multilocular renal cyst. We also report a case previously diagnosed as being a multicystic kidney; the histological study revealed, however, a cystic partially differentiated nephroblastoma. No case of extrarenal tumors was present in the misdiagnosed patients. We comment the difficulties to make a correct diagnosis when confronted with the above mentioned entities and before histological data are available.

A series of 42 children with Wilms' tumor collected in 11 years is reported. The female-to-male ratio was 1,5:1 and 85 per cent of the patients were under 5 years at diagnosis. The majority of the tumors were Stage I (38 per cent) followed by Stages III and IV. Pathological findings following Belkwith's criteria are commented upon. The 5 year survival was 72 per cent, and tumor-free survival was 62 per cent. There was a clear relationship between survival and Stage, age and the presence or absence of intra-abdominal lymph-node spread. Efficacity of preoperative chemotherapy and its' influence on the stage of tumor at operation is discussed.

Single system ectopic ureters are usually associated with multiple congenital abnormalities and the corresponding renal units is frequently abnormal. 19 cases of single system ectopic ureters were diagnosed and treated in our hospital during the last 20 years. The patients were less than 11 years old. The abnormality was bilateral in two cases and the 63% of all had associated malformations, being the anorectal abnormalities the most frequent. The incidence of reflux into the ectopic ureter was 57%, and the association to unilateral or contralateral renal agenesis, 26.3%. Thirteen ectopic ureters were reimplanted successfully into the bladder, and the cases of nonfunctioning kidneys were removed (nephroureterectomy). The follow-up period was 10 months to 14 years, developing the 68% of the cases without any complication and a good renal function. Two patients were transplanted due to a kidney failure. Diagnosis is often extremely difficult and requires a high degree of suspicion. This diagnosis may be incidental, and it may be made during investigation of patients with other malformations. An early diagnosis and treatment must be made in order to avoid a disturbance of renal function. We wish to point up the high incidence of reflux into the ectopic ureter and the high association to renal agenesis in the single system ectopic ureters in comparison with ectopic ureter of duplex system.