P.J. Lopez - Academia.edu (original) (raw)

Papers by P.J. Lopez

Archivos españoles de urología, 2010

With the increased use of minimally invasive surgery, the urethral diverticulum after anorectal s... more With the increased use of minimally invasive surgery, the urethral diverticulum after anorectal surgery has become an issue. The few cases reported have been managed by surgical excision. We hereby report a case of urethral diverticulum after a laparoscopically-assisted anorectal pull-through (LAARP)procedure with a successful outcome after a period of active surveillance. A full-term boy who displayed a high anorectal malformation (ARM) and a rectoprostatic fistula underwent colostomy on the first day. He also showed associated malformations: bilateral low-grade reflux, horseshoe kidney and thoracic hemivertebrae; however, there were no signs of spinal cord tethering. Antimicrobial prophylaxis was started. At the age of 3 months, he underwent a LAARP with a 3 abdominal-port approach. After complete dissection of the distal bowel, the recto-prostatic fistula was identified and tied with metallic clips. A 10 mm trocar was inserted through the centre of the sphincteric complex, which ...

Archivos españoles de urología, 2010

... Urol. v.63 n.4 Madrid mayo 2010. ... Pedro-José López, Yair Cadena, Angélica Paulos, Lorena A... more ... Urol. v.63 n.4 Madrid mayo 2010. ... Pedro-José López, Yair Cadena, Angélica Paulos, Lorena Angel y Ricardo Zubieta. Unidad de Urología Pediátrica. ... 1. Pastor Navarro H, Donate Moreno María J, Carrion López P, Pastor Guzmán JM, Segura Martín M, Lorido Cortés MM, et al. ...

INTRODUCTION AND OBJECTIVES: hydro and / or hematocolpos are a rare pathological condition, incid... more INTRODUCTION AND OBJECTIVES: hydro and / or hematocolpos are a rare pathological condition, incidence 1/16.000 girls, which involves dilation of vagina and / or uterus with hematic fluid or material. Due to its different forms of presentation and especially the affected age group, diagnosis may not always be easy as improper Management can determine different complications of varying severity. The aim of this paper is to analyze the cases treated in our pediatric urology service according to age group of clinical debut. MATERIAL AND METHODS: Retrospective study of patients diagnosed with hydro or hematocolpos between 2007 and 2011. Demographics, co morbidities, treatment and complications were analyzed. RESULTS: 8 girls, all with ambiguous genitalia at birth, 7 with congenital adrenal hyperplasia were analyzed. In 6 patients endoscopic examination performed under general anesthesia confirmed the presence of a urogenital sinus (SUG) at an average age of 36 months (r 3m-12a). The aver...

Archivos espanoles de urologia, 2010

SUMMARY Leydig Cell Tumors (LCT) in children are very rare, with an incidence of 1-3% for all tes... more SUMMARY Leydig Cell Tumors (LCT) in children are very rare, with an incidence of 1-3% for all testicular tumors in children. Clinical presentation is testicular mass, pain and hormone alteration such as precocious puberty and gynecomastia. We present one case of LCT and his conservative management after an incidental finding. Literature is reviewed.

Introduction: ureteropelvic junction obstruction (OPU) is the most common upper urinary tract obs... more Introduction: ureteropelvic junction obstruction (OPU) is the most common upper urinary tract obstructive uropathy, and is usually treated by open pyeloplasty. Our purpose is to analyze whether laparoscopic pyeloplasty has a similar success and complication rate as the open approach in patients of less than 10 kg. Materials and Methods: This retrospective study involved two groups of patients of less than 10 kilos: Open (group 1) and laparoscopic (group 2), operated between 2005 and 2011. We analyzed demographic data, resolution of hydronephrosis (anteroposterior diameter of the pelvis or DAP), complications of surgery, ultrasound and MAG3 pre and post surgery. Results: 34 patients were included. Both groups statistically comparable to each other. In group 1 there were 25 patients, average age of 3.7 months (r 1- �12), 16 units were left, average weight 7 kg (r3,8- �10), anteroposterior renal pelvis diameter (DAP) pre- �surgery 35,5 mm (r 10- �73) and 13,9 mm after surgery (r 3- �31...

El abordaje sagital transrectal anterior (ASTRA) resulta de amplia utilidad para el enfrentamient... more El abordaje sagital transrectal anterior (ASTRA) resulta de amplia utilidad para el enfrentamiento de patologia urologica pediatrica. Actualmente es el gold-standar en el manejo del seno urogenital alto, malformaciones vaginales, trauma uretral complejo y tumores. Presentamos una modificacion menos invasiva a este abordaje, comentando sus ventajas. En posicion decubito prono, con preparacion intestinal; se realiza una incision en “caliz”; esta consiste en una seccion vertical en linea media perianal desde horquilla vulvar a recto en mujeres, y desde base de escroto a recto en hombres, y otra incision transversa, concava, en el tejido de transicion entre mucosa rectal y piel, aproximadamente a dos centimetros del punto medio del ano. Caso 1: Nina de 13 anos, consulta por dolor pelvico, diagnosticandose duplicacion uterina y vaginal, con atresia de tercio distal de una hemivagina. Se realiza abordaje sagital anterior en caliz, resecando tabique intervaginal y realizando plastia vagina...

Journal of Pediatric Urology

Surgical training has changed radically in the last few decades. The traditional Halstedian model... more Surgical training has changed radically in the last few decades. The traditional Halstedian model of time-bound apprenticeship has been replaced with competency-based training. In our previous article, we presented an overview of learning theory relevant to clinical teaching; a summary for the busy paediatric surgeon and urologist. We introduced the concepts underpinning current changes in surgical education and training. In this next article, we give an overview of the various modalities of surgical simulation, the educational principles that underlie them, and potential applications in clinical practice. These modalities include; open surgical models and trainers, laparoscopic bench trainers, virtual reality trainers, simulated patients and role-play, hybrid simulation, scenario-based simulation, distributed simulation, virtual reality, and online simulation. Specific examples of technology that may be used for these modalities are included but this is not a comprehensive review of all available products.

Sadly, this is our last issue of this series "Update and Controversies in Laparoscopic Paediatric... more Sadly, this is our last issue of this series "Update and Controversies in Laparoscopic Paediatric Urology". In our first issue we exposed the idea that to perform big reconstructive surgeries in minimally invasive paediatric urology we should learn to "cradle", then "take some steps", subsequently "walk" and at the end to "run"….. and hopefully with some style. In this issue we should be able to learn how to "run with style". The topics in this number will go through difficult surgeries that most of paediatric urology would doubt-not with no good reasons-to perform them with MIS. Difficult pathology like urine incontinence, bladder augmentation and DSD & Vaginoplasty are beautifully discussed by our expert, trying to take all the possible points of view, just to give you a broad description of the current status of each of those conditions. Once again, the final decision to do one of these approaches or not is back to you, your team and which would be the best for your patient, but at least you have the opportunity to think about it and/or …to have it in mind. As Guest Editors, we would like to sincerely thank all our expert friends who had contributed to this series. Without their honest exposition of their techniques, their experience, their pitfalls and useful tips, this series would never come out to public light. THANK YOU very much. On the other hand, we are pretty sure that all the contributors would be more than happy to get in contact with you if there is any doubt or comments. We also would like to truly thank Elizabeth and Tony, Dialogues Editors who trust us with this "mission"; it was really our honour and pleasure to work with you. For last time, we would like to invite you to relax and enjoy the 3rd issue of the series "Update and Controversies in Laparoscopic Paediatric Urology", which hopefully will help us to "run with style."

Revista Chilena de Pediatría, 2015

Operative Pediatric Surgery 6Ed, 2006

Pediatric Surgery International, 2007

Recurrence of gastro-oesophageal reflux (GOR) following redo Nissen fundoplication represents a s... more Recurrence of gastro-oesophageal reflux (GOR) following redo Nissen fundoplication represents a significant clinical problem. The aim of this study was to identify factors predicting failure of redo Nissen fundoplication. The notes of children who underwent redo Nissen fundoplication for recurrent GOR in a single institution between June 1994 and May 2005 were reviewed. Data are reported as median (range), or as numbers of cases. Multiple logistic regression analysis, using type of first fundoplication, neurological status, presence of gastrostomy, ageweight, retching-gas bloat after first fundoplication, associated anomalies, oesophageal atresia and length of follow-up as factors, was used to generate a model to identify factors predicting recurrent vomiting (failure) after redo. Eighty-one children underwent redo Nissen fundoplication 15.9 months (0.2-176) after the initial Nissen fundoplication. In 29, the first Nissen was laparoscopic. Age at redo Nissen fundoplication was 3.3 years (0.3-15.9) and weight 12.8 kg (5-60). Thirty-four children (42%) presented with recurrent vomiting (failure). Overall, the model successfully predicted vomiting (failure) after redo fundoplication (P = 0.009). Open surgery at first fundoplication (P = 0.011) and neurological impairment (P = 0.046) were both significant predictors of redo failure in the model, whereas presence of gastrostomy (P = 0.035) and older-heavier age-weight (P = 0.028) were associated with significantly better results. Retching-gas bloat, associated anomalies and oesophageal atresia were not significant predictors of failure. Redo Nissen fundoplication has a high failure rate. Risk factors are open fundoplication at first operation and neurological impairment. Redo fundoplication after primary laparoscopic Nissen has a lower risk of failure.

The Journal of Urology, 2011

Journal of Pediatric Surgery, 2014

Advances in Urology, 2008

Purpose. The goal of this review is to present current indications, injectable agents, techniques... more Purpose. The goal of this review is to present current indications, injectable agents, techniques, success rates, complications, and potential future applications of endoscopic treatment for vesicoureteral reflux (VUR) in children.Materials and Methods. The endoscopic method currently achieving one of the highest success rates is the double hydrodistention-implantation technique (HIT). This method employs dextranomer/hyaluronic acid copolymer, which has been used in pediatric urology for over 10 years and may be at present the first choice injectable agent due to its safety and efficacy.Results. While most contemporary series report cure rates of greater than 85% for primary VUR, success rates of complicated cases of VUR may be, depending on the case, significantly lower. Endoscopic treatment offers major advantages to patients while avoiding potentially complicated open surgery. As the HIT method continues to be applied to complex cases of VUR and more outcome data become available...