[Shattered kidney in a patient with asymptomatic chronic hydronephrosis. Case report and literature review]. / Estallido renal en paciente con hidronefrosis crónica asintomática. A propósito de un caso y revisión de la literatura.

The incidence of renal anomalies in patients who suffer a renal trauma is around 4.4 and 19%. We introduce a case of a patient whose first sign of a chronic hydronefrosis was a renal burst secondary to an abdominal trauma.

[Prostate cancer in the Community of Madrid in the year 2000. III. Study of tumor extent]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. III--Estudio de extensión tumoral.

OBJECTIVE: To identify a potential relationship between two variables, risk of metastasis and use of imaging techniques, in an extension study in prostate cancer patients diagnosed in the Autonomous Community of Madrid in 2000. MATERIAL AND METHODS: 1,127 patients with available data on the tumour extension study were analysed. Performance and non performance of bone scans and CTs were correlated to risk variables for developing metastasis as described in the literature (PSA, Gleason and stage) and to therapy administered. RESULTS: The proportion of patients with risk variables for metastasis when bone scans were performed was between 7% to 14% greater than in patients with no variables. No differences were seen for CTs based on risk variables. With matching risk variables, more imaging techniques were used in patients receiving radiotherapy that in those managed with prostatectomy. CONCLUSION: Based on current recommendations imaging techniques were used in excess in the extension study in patients with no risk variables for metastasis. Conduct of a further study in the Autonomous Community seems advisable to confirm the likelihood of implementing such recommendations considering our prevalence of metastatic disease.

[Prostate cancer in the Community of Madrid in the year 2000. IV. Treatment]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. IV Tratamiento.

OBJECTIVE: To know the therapeutic options used in patients diagnosed with prostate cancer in the Autonomous Community of Madrid in 2000. MATERIAL AND METHODS: The study was conducted on 1,745 patients referred by hospitals taking part in the study. Data on treatment used was available for 1,104 (63%) patients. Treatment modality was correlated to clinical stage and patient age. RESULTS: Most frequent choice was hormone therapy (35%) followed by radical prostatectomy (34%) and radiotherapy (25%). Prostatectomy was most commonly used in patients with localised (42.3%) disease while hormone therapy was preferred for locally advanced (45.6%) or disseminated (94%) disease. There are significant differences in therapeutic indications between the various Health areas participating in the survey. Median age of patients with localised and locally advanced disease was lower in patients managed with prostatectomy (65 and 64 years, respectively) than in those managed with radiotherapy (70 and 69 years, respectively). CONCLUSION: The therapeutic modality indicated by urologists in the Madrid Autonomous Community for managing patients with prostate cancer generally meets with literature recommendations.

[The prostate cancer in the community of Madrid in 2000 I.- Incidence]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. I--Incidencia.

OBJECTIVE: To know the incidence in the year 2000 of prostate cancer in the Autonomous Community of Madrid and its breakdown by Health Areas. MATERIAL AND METHOD: Study of histologically confirmed prostate cancer case reports and retrospective data acquisition for 2000 in the Autonomous Community of Madrid, both from Public and Private Health Care hospitals. RESULTS: Gross incidence of prostate cancer in the Autonomous Community of Madrid was 100.4 cases per 100,000 males. The incidence adjusted for the Spanish, European and Worldwide population was 120.1, 103.5 and 68.6 cases per 100,000 males, respectively. Mean age at diagnosis was 70 +/- 7.8 (40-94) years, median of 70 years. The age group with higher incidence was 70 to 79 years. CONCLUSIONS: The incidence of prostate cancer in the Autonomous Community of Madrid is lower than that in the US but higher than in most countries or regions in the EU. The different way of using PSA testing in the Health Areas of the Autonomous Community may explain the differences seen in terms of incidence by Area.

[The prostate cancer in the community of Madrid in 2000. II Presentation and diagnosis]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. II--Presentación y diagnóstico.

OBJECTIVE: To know the presentation form, diagnostic method and clinical stage at the time of diagnosis in subjects with prostate cancer (PC) in the Autonomous Community of Madrid in 2000. MATERIAL AND METHOD: Data from 1745 patients with histologically confirmed prostate cancer obtained from 15 Hospitals participating in the study was analysed. The variables studied were: associated disease, reason for visiting the hospital, digital rectal examination (DRE), PSA, diagnostic method, graded Gleason score, tests performed in the tumoral extension study and tumour staging. The qualitative variables are given in percentages of the overall number and the quantitative variables are expressed as the median, standard deviation, maximum and minimum values and 25%, 50% (median) and 75% percentiles. RESULTS: 67% cases had an associated disease. In most (75%) patients the reason for visiting the hospital was prostatic syndrome. DRE revealed that 42.7% has no tumour. At the time of diagnosis half the patients had PSA levels lower than or equal to 11 ng/ml. Transrectal ultrasound-guided biopsy was used for diagnosis in 93% subjects. The most commonly reported Gleason scores were 6 (31.3%) and 7 (28.7%). In 75% subjects the disease was considered to be clinically limited to the prostate, in 12.5% locally advanced and in 12.5% metastatic. CONCLUSIONS: Most patients came to the hospital because of symptoms not related to PC. Transrectal ultrasound-guided biopsy is confirmed as the choice technique for PC diagnosis. When a comparison is made to historical series in our Autonomous Community a pattern of earlier diagnosis can be seen.

[Fibrosarcoma of the penis]. / Fibrosarcoma del pene.

A fibrosarcoma of the penis is an infrequent finding. This paper contributes one case found in the perineo-scrotal region emphasising some aspects of local staging procedures, as well as the differential diagnosis with other mesenchymal tumours; there is no validated treatment protocol, although there is widespread agreement that extensive surgical excision should be performed, such as was performed in this patient.

[Complications of inguinal lymphadenectomy for penile carcinoma. Origin, management, and prevention]. / Complicaciones en las linfadenectomías inguinales por carcinoma del pene. Origen, manejo y prevención.

Since inguinal lymphadenectomy (LFD) technique in the treatment of epidermoid carcinoma of the penis was first described, control of its high mobility has been one of the concerns for oncological urologists. Our group has reviewed the complications of 21 inguinal LFDs performed since 1982 in our centre and found that two thirds of these procedures had at least one complication, the most frequent being lower limb lymphedema (28.5%) among those appearing late, and healing alterations (38%) together with fluid collections or persistent lymphorrhea (33.3%) among the early ones. Other complications were infection, local recurrence and haemorrhage of the femoral vessels. Most authors agree on the high morbidity of this technique. We highlight the origin, management and prevention of each of these complications so as to reduce their frequency while placing inguinal LFD in its real position within the therapeutic approach of epidermoid carcinoma of the penis.

[Hemangioma of the adrenal gland]. / Hemangioma de la glándula suprarrenal.

Adrenal gland haemangioma is an uncommon tumour which finding usually occurs by chance. This paper presents one case of cavernous haemangioma in this location on which surgery was performed successfully. The basic aspects of the case are revised from a pathohistological and diagnostic point of view intended to attempt to suspect its presence preoperatively.

[Embolism in renal artery]. / Embolia sobre la arteria renal.

OBJECTIVE: To describe a useful algorithm when acute non-traumatic renal artery occlusion is suspected. METHODS: The diagnostic and therapeutic aspects of this uncommon disease are analyzed through two cases that had been managed differently. RESULTS: Early clinical suspicion is based upon a non-colic sudden flank pain in patients with a history of cardiac embolic events, increased serum LDH, ALAT and ASAT, proteinuria, non-lithiasic, non-functioning kidney on IVP and a normal sized non-dilated kidney on ultrasound. The next step is diagnostic angiography and fibrinolysis when indicated. CONCLUSIONS: Intra-arterial fibrinolysis is the treatment of choice in renal artery embolism when functional recovery by angiographic and clinical criteria is present, and will be further enhanced the earlier the diagnosis is made.

[Subcapsular renal hematoma following shock wave lithotripsy]. / Hematomas renales subcapsulares tras litofragmentación por ondas de choque.

OBJECTIVES: The present study analyzed the incidence of subcapsular hematoma of the kidney (SH) following extracorporeal shock wave lithotripsy (ESWL), its management and the possible risk factors that influence the development of this condition. METHODS: We received the records of 1600 patients submitted to 2250 ESWL sessions. SH was evaluated according to the following parameters: clinical features, diagnostic methods, management, follow up and the patient -and ESWL- related factors that influence the development of this condition. RESULTS: Five cases of SH were found (0.22% incidence), which had been diagnosed by ultrasound (US). Eighty per cent had sustained lumbar pain and a fall in hemoglobin values. The patients were managed conservatively and US follow up evaluation was done. At six months, resolution was almost complete with no sequelae. No patient had any of the risk factors described in the literature (hypertension, concomitant urinary tract infection or coagulation disorders) or changes in the ESWL unit standards. CONCLUSIONS: Although SH following ESWL is uncommon, sustained lumbar pain and a fall in hemoglobin values are risk factors that should be taken into account and corroboration and follow up by US should be done. Unless complications present, the patients should be managed conservatively.

[Functional and economic impact of the use of Wisconsin University conservation solution versus Eurocollins in relation to the period of cold ischemia in renal transplantation of cadaveric donor]. / Impacto funcional y económico de la utilización de la solución de conservación de la Universidad de Wisconsis frente Eurocollins en relación al tiempo de isquemia fría en trasplante renal de donante cadáver.

Comparison of the effect of the Wisconsin University (WU) conservation solution in the graft's functional evolution and survival, and its cost-benefit relationship versus the Eurocollins (EC) solution with regard to cold ischaemia duration in a series of 142 consecutive adults renal transplantations from corpse donor, removed with beating heart. Of 142 kidneys, 92 (64.7%) were kept in WU and 50 (35.2%) in EC. Of the WU group, 62 (67.3%) kidneys were transplanted after a cold ischaemia of under 24 hours and 30 (32.6%) after cold ischaemia of more than 24 hours. In the EC group, 23 (46%) were kept in cold ischaemia for an interval shorter than or equal to 24 hours and 27 (54%) for more than 24 hours. Incidence of initial graft dysfunction (IGD) was greater in the EC groups (65% and 78%) versus the WU groups (39% and 50%), the difference being statistically significant (p). The graft function, as indicated by the creatinine levels was always better in the WU groups. There was a decreased need for complementary dialysis sessions, less days of oliguria and shorter hospitalization in the WU groups (p). There were no significant differences in the four series with regard to rejection episodes, cyclosporin-related nephrotoxicity, and vascular and urinary tract complications. All of which turn cost-effective the higher cost per litre of the WU versus the EC solution. Graft survival at 12 and 24 months was also significantly (p) higher for grafts kept in WU. This paper presents the results obtained in the analysis of our transplanted patients. In our experience, the WU solution allows better conservation of renal grafts, with less IGD and better graft survival at 12 and 24 months. These results turn cost-effective the higher cost per litre of the WU versus the EC solution.

[Bladder embryonal rhabdomyosarcoma in the adult]. / Rabdomiosarcoma embrionario vesical del adulto.

Embryonal rhabdomyosarcoma of the bladder is a tumor thar presents sporadically in the adult patient and its treatment continues to be a controversy. One such case is presented herein. The epidemiological and histopathological features of this tumor type are described and the different therapeutic approaches advocated in the literature are discussed.

[Obstructive uropathy in Gardner syndrome: a new case and an alternative therapeutic option]. / Uropatía obstructiva en el síndrome de Gardner: un nuevo caso y otra opción terapéutica.

Gardner's Syndrome comprises numerous pathological entities, one of which is the intraabdominal desmoid tumour which can provoke obstructive uropathy through ureteral trapping. Contribution of one case treated with resection of the trapped ureter, reanastomosis and plasty with peritoneal flap. Discussion of the diagnosis, evolution, and the different therapeutical choices found in the literature.

[Reliability of CAT in the local staging of tumors of the upper urothelium]. / Fiabilidad de la TAC en el estadiaje local de los tumores del urotelio superior.

Presentation of a retrospective study where the reliability of computerized axial tomography (CAT) used in preoperative local diagnostic definition of 20 upper urothelium tumours (UUT) radically treated between 1985 and 1991 is analyzed. Of them, only 70% were located by CAT and, of these, only 56% (45% of total) obtained a clear correlation with their local infiltration stage. Thus, it is concluded that CAT alone is not a good method for the preoperative evaluation of UUTs, at least when it comes to indicate their likely conservative treatment.

[Necrotizing vasculitis located exclusively in the bladder: report of a case]. / Vasculitis necrotizante de exclusiva localización vesical: presentación de un caso.

Necrosing vasculitis and, within it, nodosa polyarteritis, is an infrequent entity characterized by the absence of pathognomonic signs and symptoms, but which can potentially affect the entire body. The initial description was made by Kussmaul and Maier in 1866. Sings and symptoms of this clinical picture are not frequently circumscribed to the urinary tract. We describe here one case of a particularly infrequent presentation, as a vesical mass with gross haematuria. The paper discusses the clinical picture, diagnosis and treatment of this process.

[Gangrenous cystitis induced by giant bladder calculus]. / Cistitis gangrenosa inducida por un cálculo vesical gigante.

Presentation of one case of gangrenous cystitis or vesical gangrene induced by the presence of a large vesical calculus in a patient with neurogenic bladder. Remarks on the patho-etiology, symptoms and treatment of this rare entity entailing a truly surgical emergence.

[Echo-Doppler duplex combined with intracavernous injection of prostaglandin E1 in the diagnosis of impotence]. / Eco-Doppler duplex asociado a inyección intracavernosa de prostaglandina E1 en el diagnóstico de la impotencia.

Sixty-two patients that had consulted for impotence were evaluated by intracavernal injection of prostaglandin E1 and duplex echo-Doppler. The internal diameter and the mean flow of the cavernosal arteries were determined by echo-Doppler in the flaccid state. Thereafter 20 micrograms of PGE 1 was injected intracavernously and the erectile response was evaluated clinically after 5 to 15 minutes. Another Doppler evaluation was performed during tumescence to study the changes of the internal diameter and the mean flow increase of the cavernal arteries. Twenty-nine patients (46.7%) achieved normal erection after intracavernal PGE 1 and the Doppler study was normal in all but 2 patients (3.2%). The remaining 33 patients (53.1%) failed to achieve normal erection following intracavernal injection of PGE 1. The Doppler study, however, was normal in 7 of these patients (11.2%), which indicates venous leak to be the underlying cause of impotence. There were minor complications (19.3%) presented a small hematoma at the site of injection and 12.9% referred moderate pain at the time of injection) and no patient has a sustained erection for more than 3 hours. The hemodynamic mechanisms and the current concepts relative to the neurologic aspects of erection are discussed. We believe duplex echo-Doppler combined with intracavernal PGE 1 to be a very reliable method in the diagnosis of impotence of a vascular origin. It can distinguish those patients that cannot achieve erection following intracavernal PGE 1 with a normal arterial tree whose impotence can be ascribed to venous leak.

[Usefulness++ of total parenteral nutrition in radical surgery for bladder cancer]. / Utilidad de la nutrición parenteral total en la cirugía radical del cáncer vesical.

Thirty patients diagnosed with non-metastatic infiltrating vesical cancer (pT2-3, NoMo) due to receive radical cystectomy and transintestinal urinary by-pass, underwent Pre-operative Nutritional Assessment (PRNA), Cystectomy, post-operative Total Parenteral Nutrition (TPN), and Post-operative Nutritional Assessment (PONA) in day 7. The purposes of this prospective, uncontrolled clinical trial were: to identify, prior to surgery, undernourished patients, to assess the effectiveness of post-operative TPN with regard to a decrease in morbidity and mortality, and to evaluate the influence of a deficient nutritional condition in the occurrence of post-operative complications. It was found the 16.6% patients were undernourished prior to surgery, 80% of which showed complications, while only 28% patients considered to be in a normal state of nutrition had complications (there were no fistulae, intraabdominal abscesses, and abdominal sepsis). 6.6% complications were TPN-related. The conclusions were: the percentage of patients with malnutrition prior to surgery is large enough to justify a routine PRNA; TPN decreases morbidity and mortality in patients with previous good nutritional state but not in those with malnutrition; undernourished patients have a very high rate of complications and surgery should be delayed until a acceptable state of nutrition is achieved.

[Current treatment of ureteral lithiasis. Review of our experience]. / Tratamiento actual de la litiasis ureteral. Revisión de nuestra experencia.

Retrospective analysis from June '89 to January '91 of 198 patients seen in our Hospital for ureteral lithiasis using 'in situ' ESWL as the first therapeutic choice. The number of sessions per calculus was 1.45, 68.7% cases receiving only one session. 84.2% calculi were resolved by ESWL, with associated instrumental manoeuvres in less than 15% cases. Our hospital's therapeutic algorithm for the 15.8% calculi where ESWL failed is presented. The conclusion is that 'in situ' shock wave extracorporeal lithotripsy represents a perfectly valid alternative for the treatment of ureteral lithiasis regardless its location.