[Hypospadias--one-stage repair]

The tubularised incised plate (TIP) is a common surgical technique used in the treatment of hypospadias. The study includes 52 urethroplasties, performed between 2007-2010. We performed Mathieu urethroplasty in 12% of the cases, Duplay urethroplasy in 88% of the cases and we used the Snoodgrass technique in 82% of the cases. The hospital stay varied between 3-8 days after surgery. We included in the study 32 patients with distal penile hypospadias, 8 with proximal hypospadias and 12 with midshaft hypospadias. To prevent fistula formation it is important to perform well sealed sutures, to interpose subcutaneous tissue between the urethroplasty and the cutaneous sutures, not to overlap the urethral and cutaneous sutures. The incidence of urethral fistula after the Duplay procedure was higher then after the Mathieu procedure, but the cases operated by the Duplay technique were manier and more difficult. The complications were more frequent in the cases with proximal hypospadias than in the cases with distal hypospadias, as well as the reintervention rate but not related to the surgical techniques. We present elements of diagnostic, embriology and etiopathogeny of hypospadias.

[Posterior urethral valves--diagnosis and primary treatment considerations]

Posterior Urethral Valves--PUV are the most common cause of bladder outflow obstruction in male infants, representig about 10% of prenatally detected hydronephrosis. The medical records of 27 patients, admitted and treated in the pediatric urology department of "Maria Sklodowska Curie" Emergency Hospital for Children, Bucharest, between 2001-2010 where reviewed. The aim of the study is to discuss the endoscopic valve ablation as the first choice treatment of PUV. Twenty-six, (96%) of ouer patients are alive, having now different ages, with serum creatinine levels < 0.8 mg/dl, at successive controls. One patient, lyear 11 mounths old, died in the pediatric nephrology department after right nephrec-tomy and left ureterostomy, 9 mounth before. Mortality rate in PUV patients has significantly decreased in the last 30 years, from 50% to less than 10% of patients. Nonetheless, morbidity related to PUV still represent an heavy burden for these patients and their doctors. Urodynamic studies help in understanding the pathophysiology of valve bladder and its effect on the urinary tract at long term follow-up.

[Endoscopic treatment of vesicoureteral reflux in children]

INTRODUCTION

Although vesicoureteral reflux (VUR) is a relatively common disease, in present there are different opinions regarding its approach by paediatric urologist, nephrologist and paediatrician. European Society for Paediatric Urology, European Association of Perinatal Medicine in collaboration with paediatric nephrologists developed--based on multicentric studies--a consensus approach for this disease. An efficient alternative is represented by endoscopic treatment.

MATERIALS AND METHODS

From January 2002 to December 2008 a number of 58 children, confirmed after mictional cistography with the diagnosis of VUR grade II - V, went endoscopic subureteral injection of dextranomer/ hyaluronic acid (Deflux). The reflux was unilateral in 21 cases and bilateral for the rest of 37. From 95 ureters, VUR was considered grade II - V in 15(15,79%), 45(47,37%), 28(29,47%) and 7(7,37%) cases. Follow-up and evaluation were based on mictional cistography and ultrasound examination.

RESULTS AND CONCLUSIONS

Reflux remitted after the first, the second or the third injection in 63(66,31%), 13(13,68%) and 1(1,05%) of the ureters. These results confirm the fact that endoscopic subureteral injection of an adequate material confers semnificative advantages. High rate of success, absence of postoperative complications, reduced period of hospitalization sustain this kind of treatment that is indicated in all grades of reflux.