[Recurrent urinary tract infections: prevention of recurrence with intravesical instillations of chondroitin sulfate and hyaluronic acid.] / Infecciones urinarias de repetición: prevención de recidivas con instilaciones intravesicales de condroitin sulfato sódico y ácido hialurónico.

OBJECTIVE: The aim of our study is to demonstrate that intravesical administration of the association chondroitin sulfate (CS) and hyaluronic acid (HA), according to our treatment schedule, is a benefit for women with recurrent urinary tract infections (RUTI), not only from a clinical point of view, but also reducing recurrences. METHODS: This is a study of 28 women diagnosed with RUTI, with a positive culture, and compatible symptoms;frethey underwent treatment according to the protocol of intravesical instillations of the combination CS 2%-1 gr + HA 1.6%-800 mg. To evaluate the effectiveness of the treatment, symptoms improvement, reduction of the number of episodes of urinary tract infection and quality of life were considered. RESULTS: In our series, we can observe an improvement of the quality of life assessed by PG-I, 66% after 12 months. It was seen that 55.6% of the patient's urine cultures became negative, while 44.4% had episodes of urinary infection, but with lower baseline symptoms intensity. DISCUSSION: Patients included in the protocol of instillation improved significantly their quality of life; in addition, to a considerable extent new urinary infections were not presented, being milder when they presented.

[The Spanish participation in the Congresses of the International Society of Urology during the 20th century]. / Participación española en los Congresos de la Sociedad Internacional de Urología en el siglo XX.

OBJECTIVES: With the occasion of the Centenary of the Constitution in 1907 of the International Society of Urology, initially named Association, we point at the topics treated and analyze the presence of the Spanish urologists in the foundation act as well as their role and contributions in the meetings during the 20th century. METHODS: We obtained the data from the information in various periodic publications, from the memories of some participant urologists and from the meeting records. RESULTS: We obtained notes from the foundation meeting of the International Association and two congresses, and also from the 25 congresses of the Society. We mainly extract data from the records edited by the meeting secretary, about the assistance of Spanish urologists and their contribution with conferences or communications and also about the relevance they have had holding positions within the organization. CONCLUSIONS: From 1907 the presence of Spanish urologists both in the Association and the International Society of Urology has been a constant. During the first half of the century, a time when our Urology was in a period of consolidation, the people in charge of the main urology departments in big hospitals in our country where the ones that could transmit their experience, with a level and quality comparable with the rest of Europeans. During the second half, once the nations recovered from wars, the scientific activity continued with an increasing Spanish contribution, which extended all over the country with the creation of the net of Social Security hospitals. They had hierarchical urology departments that performed study and analysis of their case series and started clinical and experimental research, significantly increasing the number of Spanish communications, mainly in congresses celebrated in Spanish speaking or European cities. As a consequence of their participation, three of the 25 meetings organized during the 20th century have been held in Spain. The Spanish presence in the directing boards of the society was favoured by the presence of Dr. Salvador Gil Vernet to consecutive periods.

[Penile sarcoma: a rare tumor]. / Sarcoma de pene: un tumor raro y agresivo.

OBJECTIVE: We report the case of a penile tumor presenting with lung and lymph node metastasis, with fatal evolution after the absence of response to surgery and adjuvant treatment. METHODS: Male patient presenting with a penile mass appearing progressively, with metastases. RESULTS: Partial penectomy and adjuvant chemotherapy were performed, with the appearance of a rapidly growing local recurrence which led to death of the patient in a few months. The tumor was a penile sarcoma with osteosarcomatous differentiation. CONCLUSIONS: Penile sarcoma is an unfrequent tumor that has a very aggressive behavior, requiring early diagnosis and aggressive management. It has tendency to local recurrence, and when it presents with distant metastases is lethal within a few months.

[Bilateral renal lymphangiomatosis: conservative management]. / Linfangiomatosis renal bilateral: actitud conservadora.

OBJECTIVE: Lymphangiomatosis is a benign disease of difficult diagnosis. The bilateral form is very rare, being in some cases an incidental finding. METHODS: We report the case of a female patient with the incidental radiological diagnosis of bilateral lymphangiomatosis, who did not present symptoms in relation to the disease. RESULTS: After a meticulous study with ultrasound, abdominal CT scan and the MRI the diagnosis was asymptomatic bilateral lymphangiomatosis and expectant management was decided with good outcome. CONCLUSIONS: Most cases reported have been treated by nephrectomy for diagnosis, but in our case it was possible to do precise diagnosis adding the experience of the radiologist and the urologist and she had a good outcome with conservative management.

[Cavernous hemangioma of the bladder]. / Cavernomatosis vesical: una patologia infrecuente.

OBJECTIVE: Certain pathologic entities should be ruled out in the diagnostic work up of hematuria, because they are so rare that if they would not share diagnostic tests with more frequent urological diseases they could be missed. The cavernous haemangioma of the bladder is one of them. METHODS: We report the case of a male patient presenting with rectal bleeding and hematuria with the diagnosis of rectal-vesical cavernous haemangioma. RESULTS: After 8 years of follow-up he did not need surgical treatment, only blood transfusions at the time of diagnosis. He has self limited episodes of hematuria not requiring aggressive therapy. CONCLUSIONS: The cavernous haemangioma of the bladder is a rare disease presenting as bleeding bladder excrecent lesions that do not require surgery as first treatment option if the bleeding is not life-threatening.

[Hand-assisted laparoscopic radical nephrectomy vs. open nephrectomy in the treatment of clinically localized renal cell carcinoma. Comparative study]. / Nefrectomía radical laparoscópica asistida por la mano frente a nefrectomía abierta en el tratamiento del carcinoma de células renales clínicamente localizado. Estudio comparativo.

INTRODUCTION: The description of the first laparoscopic nephrectomy made a revolution in the managing of the benign and malignant renal diseases. Hand-assisted laparoscopy (HAL) was developed with the aim of offering advantages to both patients and surgeons. The aim of the present work is to compare, in our experience, the results offered in the radical nephrectomy by HAL and open surgery, by analysis of surgical time, estimated blood loss during surgery and hospital stay. METHODS: Eleven Hand-assisted laparoscopic (HAL) radical nephrectomies and eight open radical nephrectomies were carried out at our institution during the same period (June 2001 to December 2002). All patients underwent computed tomography and were found to have a clinically localised functioning renal mass in all cases. The size of this renal mass was 4-7 cm (average 5.5 cm) in the HAL group and 4.5-15 cm (average 7.8 cm) in the open group. Patient age, body mass index, and American Society of Anaesthesiologists' score showed no significant difference between groups. RESULTS: The average surgical time in the HAL group was 156.72 minutes, the average blood loss during surgery was of 83.6 ml and the average hospital stay was of 3.09 days. Conversion to open surgery was not necessary in any patient. Average surgical time in the open surgery group was 178.25 minutes, the estimated blood loss during surgery was of 337.75 ml (p < 0.05) and the hospital stay was of 5.37 days (p < 0.05). The comparison of the means by two-tailed student's t test revealed significant differences in estimated blood loss and hospital stay, favoring HAL, and no significant differences in surgical time. CONCLUSIONS: HAL nephrectomy is feasible in almost all nephrectomies and is a safe, reproducible, and minimally invasive technique to perform extirpable renal surgery. HAL offer clear advantages over traditional open surgery, including decreased blood loss and hospital stay.

[Fatal evolution of a renal angiosarcoma]. / Evolución fatal de angiosarcoma renal.

OBJECTIVES: Report a new case of renal angiosarcoma treated by surgery and adjuvant chemotherapy with bad results. METHODS: 72-year-old male undergoing right nephrectomy for renal tumor. Pathology reports renal angiosarcoma. RESULTS: Three months after surgery patient refers lumbar pain and hemoptysis and CT scan reveals the existence of multiple bone and lung metastasis; a regimen of systemic chemotherapy with Doxorrubicine+ Ifosfamide was started without response; he died two months later. CONCLUSIONS: Primary renal angiosarcoma is very rare, with less than 10 cases in the literature before 1998, and it is always associated with bad prognosis. Diagnosis is based on immunohistochemical studies (antibodies against CD31, CD34 and factor VIII related antigen) to define the endothelial differentiation of the tumor. There is no experience to define the best therapeutic strategy against this entity.

[Relation between hypertension and clinical cases of benign prostatic hyperplasia]. / Estudio de la relación entre hipertensión y caso clínico de hiperplasia benigna de próstata.

OBJECTIVES: To confirm the relationship between hypertension and lower urinary tract symptoms (LUTS) in our environment, and to evaluate the association between hypertension and LUTS secondary to benign prostatic hypertrophy (BPH). METHODS: We prospectively studied during 3 months all male patients older than 50 years (163 patients) analysing previous medical history, IPSS, digital rectal examination, urine sediment, basic biochemical profile, PSA, uroflowmetry, and urinary tract ultrasound. Patients with neurological diseases, previous pelvic trauma, diabetes mellitus, suspicious digital rectal examination, abnormal PSA, or under treatment with alpha blockers, antidepressants, finasteride or antipsychotic drugs were excluded. RESULTS: From a total of 163 patients 113 were classified as suffering clinical BPH (LUTS, prostate greater than 30 gm, and uroflowmetry < 15 ml/sec), and 75 as hypertensive. Among 75 hypertensive patients 31 presented IPSS greater than 7 (41.3%) in comparison to 20 out of 88 non hypertensive patients (22.7%), being the difference statistically significant. CONCLUSIONS: Our study confirms what has been previously reported by other authors, that there is a statistically significant relationship between hypertension and LUTS secondary to BPH.

[Urachal cysts during childhood]. / Quistes uracales en la infancia.

OBJECTIVE: To assess diagnosis and treatment of uracal cysts. METHODS: We reviewed the medical records and radiological studies of four patients who were treated for a urachal anomaly: two urachal cysts and two urachal abscesses. Diagnostic evaluation included, ultrasound, computerized tomography and magnetic resonance. RESULTS: Treatment of urachal abscesses involved drainage and secondary excision. The urachal cyst does not require surgical intervention. CONCLUSIONS: Ultrasound is an excellent diagnostic tool for patients with urachal cysts. Infected cysts may present with pain, tenderness and erythema in the infraumbilical region. Extraperitoneal excision is the treatment of choice, although large infected cysts may require an initial drainage procedure.