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Seville, United States

Study the role of the pediatric urologist in the treatment of CAH and the satisfaction of families and patients to identify the psychosocial aspects that we can improve. Retrospective study in girls with CAH treated in our center. We reviewed the medical records, analyzing the variables: place of birth, age at diagnosis, surgery, complications and follow up. Analysis of satisfaction and psychosocial aspects by telephone survey. Between 1975-2011, 25 girls with CAH have been treated in our center. Cystoscopy and vaginoscopy was performed before clitoroplasty in 68% (16 girls), adding vulvovaginoplasty in 40% and vaginal descent in the 20%. The mean age was 8.78 +/- 2.30 months. Vaginal stenosis was the main complication (36%), performing introitus plasty in two girls, vaginal expansion in other 2 and dilation of the rest. 15 surveys were made, all expressed satisfaction with treatment, and only 6.67% reported shortages information. With the aesthetic results of the genitoplasty 20% showed dissatisfaction. The family concern was constant at 60%, and sporadic in the rest. 13.3% required psychological support. Currently 80% have normal psychosocial life. The HSC requires a multidisciplinary approach right from birth to allow adequate psychosocial development. The pediatric urologist has an important weight in the multidisciplinary treatment. Realizing early feminizing genitoplasty decreases family impact and increases satisfaction. The prolonged follow-up will allow the detection and treatment of complications. Source


Leon-Hernandez M.A.,Jefe del Servicio de Cirugia Plastica | Acosta-Leon J.,Servicio de Urologia Pediatrica | Cardenas-Camarena L.,Especialista en Cirugia Plastica
Cirugia Plastica Ibero-Latinoamericana | Year: 2015

Prune Belly Syndrome is a rare congenital disease in which besides the genitourinary manifestations, the abdominal wall is affected in all patients with various degrees of involvement. We present the case of a male with a follow-up of 15 years, during which 2 surgeries were performed in the abdominal wall: the first at age 8 with the Montfort technique, and the last one 14 years afterwards to correct skin folds and abdominal asymmetry, carrying out and abdominoplasty with the Grazer approach to achieve a better containment through a polypropilene mesh and enhancement of abdominal wall aesthetics. There were no complications during the 2 procedures and very satisfactory aesthetic results were obtained. We propose a surgical alternative for those cases in which the first surgery does not resolve wall defects and abdominal aesthetics. Source


Lasso-Betancor C.E.,Servicio de Urologia Pediatrica | Castellan M.,Servicio de Urologia Pediatrica | Yanes R.,Servicio de Urologia Pediatrica | Labbie A.,Servicio de Urologia Pediatrica | Gosalbez R.,Servicio de Urologia Pediatrica
Actas Urologicas Espanolas | Year: 2012

Purpose: In spite of advances in minimally invasive endoscopic surgery, open dismembered pyeloplasty continues to be used in many pediatric centers, especially in small children. The purpose of this work is to present our experience in the performance of this technique using a minimally invasive open pyeloplasty without intrarenal stents. Material and methods: A retrospective review was made of patients between July 1992 and July 2009. During this time, 348 patients underwent open dismembered pyeloplasty. A total of 310 patients (89%), 223 boys and 87 girls, underwent open pyeloplasty without intrarenal stent. The incision was from 2 to 2.5 cm in the flank. An extrarenal drain (3-5 days) and a bladder catheter (< 24 hs) were placed in all patients. Results: A total of 319 pyeloplasties were performed without intrarenal catheter in our Service. Of these, 174 (54.5%) were on the left side, 127 (39.8%) on the right side and 9 (5.6%) were bilateral. Age interval was 14 days to 18 years, 58% of the children being younger than 12 months at the time of surgery. With a mean follow-up of 6.7 years (17 years to 11 months), 312 pyeloplasties (97.8%) were successful, with persistence of the obstructive patient in 7 patients who required a new open pyeloplasty (2.2%). Other complications were: prolonged drainage (6), wound infection (1), and urinary infection (2). Mean stay was 22 hours. Conclusions: Open dismembered pyeloplasty is a safe and effective treatment choice for pyeloureteral stenosis in children and can be done without intrarenal stents with no detriment to its success. © 2011 AEU. Published by Elsevier España, S.L. All rights reserved. Source

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