[Renal hematomas after extracorporeal lithotripsy with the lithotriptor "lithostar multiline de Siemens"]. / Hematomas renales tras litotricia extracorpórea con el litotriptor "lithostar multiline de siemens".

OBJECTIVE: Renal haematomas after extracorporeal shockwave lithotrity are an immediate and potentially serious complication. The incidence of post-ESWL renal haematoma with the new Siemens' Lithostar Multiline lithotripter is analyzed in an attempt to know its occurrence, predisposing factors and presentations signs and symptoms. MATERIAL AND METHODS: Between January and December 1998, a total of 1313 extracorporeal shockwave lithotrity sessions were performed on lithiasis located at any level of the urinary tract in 686 patients. Treatment were performed with a Lithostar Multiline lithotripter (electromagnetic generator). The power used ranged from 4 to 9 units, which are power steps based on load tension in Kv, pressure peaks in bars and energy flow density in mJ/mm2, with an average of 3800 pulses/session. A radiological study (ultrasound-tomography) was conducted when faced with clinical suspicion of complications. RESULTS: A total of 7 clinical renal haematomas (1.02%) were diagnosed. A conservative attitude was taken in most cases. One patient presented hemodynamic instability and required surgery to empty the haematoma and haemostasia of the renal unit, though no nephrectomy was finally required. As predisposing factors: presence of HBP, prior ESWL and hypercholesterolemia are all emphasized. In rare cases several factors concurred simultaneously in the same patient. CONCLUSIONS: Renal haematoma should be suspected in the presence of continuous or unjustified pain after ESWL treatment. Any likely coagulation disorder should be corrected, urinary infections ruled out and pressure figures controlled.

[Late metastasis in thyroid gland after nephrectomy for renal clear cell carcinoma]. / Metástasis tardía en glándula tiroidea tras nefrectomia por carcinoma renal de células claras.

Renal carcinoma natural history is unpredictable. Spontaneous metastases regression after nephrectomy, as well as late recurrence are suggestive of this peculiar human neoplasm. tumor metastases localized to thyroid gland are uncommon in clinical practice; and carcinoma of the kidney, breast, lung, melanoma and gastrointestinal tract tumors are responsible for the majority of them. This paper reports on a patient with metachronous thyroid gland metastases after fourteen years of renal carcinoma nephrectomy, with one year after hemithyroidectomy recurrence on cervical striated muscle followed by surgical excision. Therapeutical aspects are briefly reviewed in literature, emphasizing surgical treatment and the need of all-life follow-up, with more alert attitude toward thyroid gland after renal cell carcinoma nephrectomy.

[Obstructive uropathy secondary to genitourinary prolapse]. / Uropatía obstructiva secundaria a prolapso genitourinario.

Genital prolapse is associated to a greater concurrence of repeat urinary infections, stress urinary incontinence, arterial hypertension and obstructive uropathy with a higher or lower degree of renal impairment. Incidence of uropathy in the genital prolapse setting ranges between 4 and 13%. This paper presents a female patient with renal insufficiency secondary to bilateral obstructive uropathy caused by a concomitant genital prolapse. A brief revision is made of the pathophysiological, diagnostic and therapeutic aspects in the literature. The need to perform both prone and standing urographic studies is emphasized; also a study of the renal function should be performed in these patients in order to establish the appropriate treatment and avoid major complications and renal function impairment.

[Obstruction of the urethral conduct following implantation of the endoprosthesis Urolume: therapeutic management]. / Obliteración de la luz uretral tras implante de endoprotesis urolume: manejo terapéutico.

The introduction of self-expandable urethral endoprostheses for the management of relapsing urethral stenosis has required the development of a minimally invasive therapeutical approach of widespread acceptance by the urological community. The reason for its success is the simplicity of implantation and the low rate of complications up to date. This paper reports on a patient carrying a ¿Urolume¿ urethral endoprosthesis for a relapsing bulbar urethral stenosis, which two years after implantation presents re-stenosis secondary to endoluminal inflammatory tissue growth. After two failure endoscopic resections, endoscopic removal of the prosthesis was required. Currently the patient carries a ¿Urocoil¿ spiral endoprosthesis to avoid tissular reaction. The therapeutical aspects found in the literature are reviewed, emphasizing the need of follow-up to detect complications, to improve indications and to select those patients that may be candidates for this treatment.

[Mixed urogenital schistosomiasis]. / Esquistosomiasis genitourinaria mixta.

Urinary schistosomiasis is a parasitosis caused by Schistosoma Haematobium which affect in a diffuse manner all the genitourinary tract. Presentation of 5 patients (4 male, 1 female) with mixed Bilharziosis that was detected after the study of a young male that came to the clinic with a complaint of haematuria and who underwent transurethral resection under the suspicion of a vesical urothelial neoformation. Sch. Hameatobium eggs were detected in the urine and Sch. Mansoni in the semen of all 4 male. All of them evolved favourably with Praziquantel. Considering the rarity of schistosomiasis in our environment and its increased incidence in endemic areas, this process should be included in the algorithm of differential diagnosis in young patients reporting dysuric syndromes associated to haematuria; the relevance of an epidemiological anamnesis so as to institute early treatment and avoid the consequences of chronic infection is pointed out.

[Ureteral obstruction secondary to inflammatory iliac aneurysm]. / Obstrucción ureteral secundaria a aneurisma ilíaco inflamatorio.

Inflammatory iliac aneurysms are uncommon and account for 1-2% of total abdominal aneurysms. These aneurysms are more susceptible to present urological symptoms and are difficult to diagnose because of their uncommon incidence and location in the deep pelvis which makes them little accessible to physical examination. This case report presents one patient with right obstructive uropathy secondary to extrinsic ureteral trapping due to inflammatory iliac aneurysm which evolved favourably after ureterolysis, endoaneurysmectomy and interposition of aortoiliac graft. A brief review of diagnostic and therapeutic aspects in the literature is included. The relevance of a high degree of suspicion to diagnose this entity in patients with otherwise explainable vesical irritative symptoms, haematuria or renal failure is highlighted.

[Skin metastasis as first manifestation of prostatic adenocarcinoma]. / Metástasis cutáneas como primera manifestación de un adenocarcinoma prostático.

Incidence of prostate disease has seen a sudden boost over the last few years as a result of an increase in male life expectancy. Prostate carcinoma is the third most common cause of cancer mortality in Spain. Post-mortem studies reveal that this is the most prevalent neoplasia in the elderly. 30% of all males over 50 years could host malignant cells in their prostate, although only 20% of these neoplasias have clinical manifestations. Prostate carcinoma expansion occurs by local spreading, as well as lymph and blood dissemination. Local spreading to the urethra, bladder neck, trigonous and seminal vesicles is frequent. Lymph dissemination to obturating, hypogastric, iliac, presacral and paraaortic nodes is a major path for metastasis. Bone metastasis with increased acid phosphatase is the most illustrative sign of prostate adenocarcinoma expansion. Visceral metastasis occur more frequently in lungs, liver and renal glands. There is a 0.3% likelihood of skin metastasis from prostate adenocarcinoma. Considering the rareness of skin metastasis from prostate adenocarcinoma, the case reported in the present paper, first evidence of a prostate carcinoma, is even more exceptional.

[Renal carcinoma and von Hippel-Lindau disease]. / Carcinoma renal y enfermedad de Von Hippel Lindau.

Von Hippel Lindau disease is a highly uncommon autosomic dominant condition characterised by the presence of cerebellar hemangioblastomas, retina angioma, pancreas, kidney and epididymal cysts, and renal cells carcinoma. This article describes the case report of a male patient with Von Hippel Lindau disease which presented as a jaundice secondary to biliary obstruction due to pancreatic cystic mass. After urological examination, bilateral cystic lesions and right renal solid lesion were detected requiring surgical treatment. A review is made of the diagnostic and therapeutic aspects, highlighting the significance of early diagnosis and treatment.

[Cryptorchidism and testicular cancer]. / Criptorquidia y cáncer testicular.

OBJECTIVE: This report underscores the higher risk of testicular cancer in cryptorchidism. METHODS/RESULTS: A patient undergoing evaluation for sterility, who was submitted to orchidopexy 15 years earlier for cryptorchidism, developed a seminoma-like tumor one year following a testicular biopsy that was compatible with testicular atrophy, but with no signs of dysplasia. The literature on the epidemiology, pathogenesis, diagnosis, and treatment is briefly reviewed. CONCLUSIONS: Cryptorchidism is the single factor that carries a higher risk of testicular cancer. This condition has been reported to have 3.5 to 5 times greater risk of progressing to malignancy compared to normal descended testes. Although orchiopexy does not prevent the risk of malignancy, it permits earlier detection. The need to follow these patients closely is underscored.

[Renal hydatidosis: importance of preoperative diagnosis]. / Hidatidosis renal: importancia del diagnóstico preoperatorio.

OBJECTIVE: We report on a patient who underwent a right nephrectomy for a mass suggesting hypernephroma, which was shown to be renal hydatid disease on pathological examination. METHODS/RESULTS: The epidemiological, diagnostic and therapeutic aspects described in the literature are briefly reviewed. CONCLUSIONS: Although uncommon, renal cystic lesions should be suspected in the presence of a renal mass and a differential diagnosis should be made. CT is the most useful diagnostic imaging technique. The importance of preoperative diagnosis for the surgical strategy is underscored.

[Ectopic ureter in prostatic urethra. Unusual discovery in an adult]. / Uréter ectópico en uretra prostática. Descubrimiento inusual en adulto.

OBJECTIVE: Ectopic ureter is a congenital anomaly more frequent in the female, in the pediatric age and is commonly left-sided. The present article reports an uncommon case without the common features of this anomaly. METHODS/RESULTS: We report on a 67-year-old man with complete duplex system and ectopic obstructive megaureter in the prostatic urethra with a silent onset. The diagnostic and therapeutic aspects in the literature are briefly discussed. CONCLUSION: Because this anomaly is asymptomatic and incidentally discovered because of contralateral disease, the approach is conservative.

[Cystic pyeloureteritis. A diagnosis to keep in mind]. / Pieloureteritis quística. Un diagnóstico a tener en cuenta.

OBJECTIVES: Cystic pyeloureteritis is a disease entity of unknown etiology and unspecific symptoms. It is incidentally detected and is difficult to distinguish from other disorders showing filling defects on urographic evaluation. All the foregoing prompted us to report the present case. METHODS/RESULTS: We report a case of cystic pyeloureteritis that had been diagnosed during ureterorenoscopy in a patient with lithiasis and recurrent urinary tract infection. The etiopathogenesis, diagnostic and therapeutic aspects described in the literature are briefly reviewed. CONCLUSIONS: We underscore the importance of confirming the diagnosis by endoscopic and cytological studies. Conservative management is advocated. Patient follow up should include urinalysis, urine culture and cytology twice yearly and intravenous urography once a year.

[Penile prosthetic implant in the treatment of impotence: our experience]. / Implante de prótesis de pene en el tratamiento de la impotencia: nuestra experiencia.

The aim of this study was to review the current situation of penile prostheses in the treatment of erectile dysfunction and to analyze the indications, degree of acceptability and complications in our experience. From 1987 to 1993, 35 implants were inserted in men suffering from impotence due to different etiologies. The mean age was 54 years and the mean duration of erectile dysfunction was 37 months. Diabetes, vascular disease and pelvic surgery were the most common pathologies recorded. We utilized the penoscrotal approach in 97.14% of the cases and implanted the following prostheses: 12 Hydroflex, 7 Uniflate 1000, 6 Acuform, 4 Mark II, 3 Dynaflex and 3 Alpha 1. The mean follow-up was 38 months. Infection of the prosthesis by Staph. epidermidis was observed in 5.71% of the cases. This infectious complication required removal of the prosthesis. Two patients with a Uniflate prosthesis complained of mechanical failure. Eighty percent of the patients and 74.28% of their partners were satisfied with the results. When asked if they would undergo another operation again if it were necessary, 71.42% answered "yes". Penile prostheses have withstood the test of time and continue to be an effective and valid therapeutic alternative in impotent men. Although the complication rate is low, adequate information must be provided to the patient and partner in order to enhance the results.

[Multiple matrix lithiasis: integral endourological treatment]. / Litiasis matricial múltiple: terapéutica endourológica integral.

OBJECTIVES: Matrix stone, characterized by mucoproteic urinary deposits, is an uncommon lithiasic disease. The low frequency of this disease and the interest in its therapeutic management prompted us to report on the present case. METHODS/RESULTS: A case of multiple nephroureteral matrix calculi is described. Treatment was by integral strategic lithoreductive therapy: ureterorenoscopy, percutaneous nephrolithotomy and N-acetylcysteine prophylactic chemolysis. The clinical features, diagnostic and therapeutic aspects described in the literature are briefly reviewed. CONCLUSIONS: Complete stone removal to avoid recurrence is emphasized. Regular follow up and adequate treatment of the urinary infections are recommended.

[Inappropriate antidiuretic hormone secretion syndrome: a rare manifestation of prostatic adenocarcinoma]. / Síndrome de secreción inadecuada de hormona antidiurética: una rara manifestación de adenocarcinoma prostático.

OBJECTIVE: Prostatic cancer can produce signs and symptoms by local growth, direct invasion or distant metastases. In rare occasions, these tumors can show a clinical variance due to trophic factors, biologically active, secreted in neoplastic environment but with systemic relevance. These syndromes are called paraneoplastic syndromes. This uncommon condition is described herein. METHOD/RESULTS: We report a case of inappropriate antidiuretic hormone secretion as the presenting feature of advanced prostatic carcinoma. The pathogenic features, diagnostic and therapeutic aspects are reviewed. CONCLUSIONS: Although its frequency is low, we must consider prostatic carcinoma in patients with inappropriate antidiuretic hormone secretion syndrome. When the acute situation is resolved, hormonal treatment in disseminated carcinomas will return to normal the clinical and analytical parameters derived from this syndrome.

["Sand-clock" lithiasis on prostatic transurethral resection bed]. / Litiasis en "reloj de arena" sobre celda de resección transuretral prostática.

OBJECTIVES: Although uncommon, prostatic surgical bed lithiasis may present among post-TURP complications. The present study underscores the importance of diagnosis and treatment. METHODS/RESULTS: We report on a patient with magnesium ammonium phosphate hourglass lithiasis in the prostatic surgical bed one year and a half following transurethral resection due to adenomyomatous prostatic hyperplasia that was successfully treated by intracorporeal lithotripsy with the Lithoclast. The physiopathological, clinical, diagnostic and therapeutic aspects are discussed. CONCLUSIONS: This condition should be suspected in patients with dysuric syndrome post-TURP. The importance of simple complementary diagnostic procedures as DRE and plain abdominal films in discarding lithiasis in underscored. We consider retrograde endoscopic manipulation and ultrasonic lithotripsy or penumatic lithotripsy with the Lithoclast to be the safest procedures for this type of lithiasis.

[Ureteral endometriosis]. / Endometriosis del uréter.

OBJECTIVES: Ureteral involvement due to endometriosis is uncommon. Its silent onset and the progression of ureteral obstruction, if undiagnosed, can lead to the loss of the renal unit. The present case is described to underscore the importance of early diagnosis. METHODS/RESULTS: We report on a patient with obstructive uropathy secondary to intrinsic ureteric endometriosis that had undergone nephrectomy due to parenchymal destruction. One year following resection of the endovesical portion, recurrence in the ureteral stump was observed. The clinical features, the diagnostic and clinical aspects are briefly discussed. CONCLUSIONS: Although ureteric involvement is uncommon, renal function of patients with pelvic endometriosis must be followed closely by analyses, ultrasound and/or intravenous urography for early detection of this condition.

[Megacalycosis and lithiasis]. / Megacalicosis y enfermedad litiásica.

OBJECTIVES: Megacalycosis or Puigvert's disease is a clinical entity characterized by dilatation of all renal calyces without dilatation of the renal pelvis or ureter in the absence of any obstructive factor. To date, its pathogenesis remains unclear. The rarity of this disease and the importance of making a correct differential diagnosis prompted us to report on the present case. METHODS/RESULTS: Two patients with urolithiasis associated with ipsilateral megacalyces who were successfully treated by ESWL are described. The clinical, diagnostic and therapeutic aspects reported in the literature are briefly reviewed. CONCLUSIONS: There is a greater lithogenic predisposition in these patients. Intravenous urography has proved to be very accurate in making the differential diagnosis from other disorders such as obstructive uropathy and intermittent hydronephrosis. The efficacy of ESWL in the treatment of lithiasis associated with megacalycosis is underscored. A yearly control follow up by analyses and intravenous urography is advocated.

[Surgical treatment of hypospadias. Our experience and follow up in 1993-1998]. / Tratamiento quirúrgico del hipospadias. Nuestra experiencia y seguimiento durante el período 1993-1998.

OBJECTIVE: To review our series of hypospadias. The incidence of the different types of hypospadias and the complication rates according to the different surgical techniques and materials utilized are analyzed. METHODS: We reviewed our series of 130 patients with hypospadias who underwent surgical correction at the Department of Pediatric Urology from 1993-1998. RESULTS: The patients presented the following types of hypospadias: glandular (13 cases), balano-preputial (56), distal penile (42), mid-penile (9), proximal penile (2) and penoscrotal hypospadias (8). The surgical techniques utilized were the Mickulitz meatotomy procedure (6 cases), MAGPI (24), Mathieu (77), Crawford (5), onlay (7), Duckett (3), Retik (4), Duplay (1), Denis-Brown (2) and penoscrotal transposition (1). The complications commonly observed were fistula (20 cases), hematoma (4), stricture of urethral meatus (4), infection (3), megaurethra (3), skin necrosis (1). CONCLUSIONS: Surgical repair of this developmental anomaly is performed when the patient is approximately 18 months old. In our series 15% of the patients developed fistula, which is similar to the complication rate reported in the literature. However, since we started using monofilament resorbable material, the incidence of fistula has dropped from 20% to approximately 5%. Although other factors are involved, the lower incidence of fistula formation may be largely due to a reduced tissue reaction to foreign body.