Prediction of the energy required for extracorporeal shock wave lithotripsy of certain stones composition using simple radiology and computerized axial tomography.

OBJECTIVE: To demonstrate that urinary lithiasis have a specific susceptibility to fracture through extracorporeal shock wave lithotripsy (ESWL), which is common for all calculi with the same composition and which can be estimated before treatment using CT or plain x-ray. MATERIAL AND METHOD: We present an in vitro, prospective, randomized, blind and multi-centre study involving 308 urinary calculi. 193 of these met the inclusion criteria: whole calculi composed purely of calcium oxalate monohydrate (COM), uric acid (UA) or carbonate apatite (CA), or a mix of oxalate (COMix) and of a size greater than 0.5 cm. The samples were broken using lithotripsy until reaching a pre-established level of comminution. The variables employed were energy dose (Edose) per cm(3) of lithiasis and Edose adjusted to lithiasic surface (EdAJ) per cm(3). RESULTS: COM was the hardest, requiring an Edose of 119,624 mJ/cm(3) and an EdAJ of 36,983 mJ/cm(3), followed by COMix (75,501/36,983), CA (22,734/21,186) and UA (22,580/6,837) (P < .05). Gmax y Gmda were correlated with Edose (r = 0.434/r = 0.420) and EdAJ (r = 0.599/r = 0.545) (P < .01). UH were correlated, in bone window and soft tissue window, with Edose/cm(3) (r = 0.478/r = 0.539) y EdAJ/cm(3) (r = 0.745/r = 0.758) (P < .01). CONCLUSIONS: In our in vitro research lithiasis require, due to the specific nature of their composition, a given amount of energy in order to be broken by ESWL, which is inherent to all those sharing the same composition, and can be predicted using CT or plain x-ray.

[Renal oncocytoma. Review of our 22 patients]. / Oncocitoma renal. Revisión de nuestra serie de 22 pacientes.

UNLABELLED: Renal oncocytoma (OR) is a benign tumor. It may represent up to 3-7% of solid kidney masses, and shows specifics cellular and evolutive characteristics. Metacronicity, multifocality and bilateralism has been reported. MATERIALS AND METHODS: Between 1986 and 2005, 478 kidney tumors have been surgically treated at our institution. We report the frequency and characteristics of OR in our patients, compared with renal cell carcinomas (RCC). We try to find out the rate of multifocality, bilateralism and other tumor association, and the number of neoplasms originally diagnosed as OR before surgery. Mean and median follow up: 36.86 and 13 months (1-193). Specific survival rate 100%. RESULTS: We found 24 OR in 10 men and 12 women with a mean age of 59 years (34-84). 12 in the left kidney and 12 in the right one, one patient presenting oncocytomatosis. Tumor mean size was 4.64 cm (1-12.5 cm). Tumors were discovered incidentally in 17 cases. Presentation symptoms in the rest of patients were gross hematuria. CONCLUSIONS: The rate of OR found in our sample population of renal tumors undergoing surgery matches other series already published. Two synchronic OR, but not metacronous, bilateral or metastatic tumors were found. All cases presented a benign evolution.

[Xanthogranulomatous pyelonephritis in childhood. A case report]. / Pielonefritis xantogranulomatosa en la infancia. A propósito de un caso.

Xanthogranulomatous pyelonephritis is an uncommon chronic inflammatory renal disorder. Most cases have been described in middle aged women and it is extremely rare in children. We report a case of a 4 year old girl who suffered from recurrent urinary tract infection and antibiotic therapy resistance. She had low growth-rate and palpable left renal mass on examination and was confirmed by radiological findings. We performed left kidney partial resection and then histological examination showed focal xanthogranulomatous pyelonephritis. The focal form of the disease may respond to antibiotic treatment although usually an enucleation or partial resection must be performed. In conclusion xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass and recurrent urinary tract infection in childhood.

[Cystic ureteritis in a kidney transplantation candidate]. / Ureteritis quística en paciente candidata a trasplante renal.

Cystic ureteritis is a very uncommon pathology, whose pathogenesis is not well established. It is usually asociated with chronic infectious factors. It presents unspecific symptoms but characteristic radiologic findings. There is not an especific treatment for this disease. Kidney transplant is the final pathway for patients with chronic renal failure. We report a case of cystic ureteritis diagnosed during pre-transplant study.

[Kidney pelvis hemangioma as a cause of hematuria]. / Angiomatosis pélvica como causa de hematuria.

UNLABELLED: Kidney hemangiomas are congenital vascular anomalies with an unknown ethiology. They are considered as benign tumours with a poor clinic expression (hematuria or ureteric colic, which is associated to the drop of clots in the urinary tract). OBJECTIVE: To expound a case of unilateral severe hematuria in a young woman with a restless past medical history, due to a pelvic left kidney hemangioma. MATERIALS AND METHODS: Clinic case of a sixteen years old woman, no relevant past medical history, presented with an anaemizing gross hematuria and passing vermiform clots. As diagnostic techniques we used ultrasonography, excretory urography, cystourethroscopy, CT, angiography and nuclear imaging. Surgery (flank nephectomy) was needed for treatment. RESULTS: Pathology report: submucosal vascular proliferative process in kidney pelvis composed by blood vessels, suggesting haemangioma.

Peripheral afferent nerve stimulation for treatment of lower urinary tract irritative symptoms.

OBJECTIVES: To assess the efficacy of posterior tibial nerve stimulation for treatment of lower urinary tract irritative symptoms (urgency, frequency, urge incontinence and pelvic pain). PATIENTS AND METHODS: 51 female patients with a mean age of 55 years were enrolled in the study. The patients presented with the following symptoms: Frequency/urgency 26 patients (50.98%), urge incontinence 22 (43.13%) and interstitial cystitis 3 patients (5.88%). The technique consists in administering low voltage electric stimulation via a 3-5cm needle placed above the tibial malleolus. Patients received weekly stimulations of 30 minutes for a 10-week period. Quality of life questionnaires and voiding diaries before and after treatment were completed. Moreover, the results were evaluated by patients. The variables analysed include: daytime and nighttime voiding frequency, daytime and nighttime voiding volume, daytime and nighttime leakage episodes and hypogastric pain. RESULTS: A statistically significant improvement was seen in all variables, especially remarkable in relation to frequency/urgency, impact on women quality of life and hypogastric pain, being less marked in relation to leakage episodes and voiding volume. CONCLUSIONS: Afferent nerve stimulation offers an alternative treatment for managing lower urinary tract irritative symptoms. However, it would be advisable to confirm the results obtained by means of long-term randomized, follow-up studies.

[Adrenal gland hematoma due to rupture of myelolipoma. A case report]. / Hematoma suprarrenal por rotura de mielolipoma. A propósito de un caso.

The myelolipoma is a benign tumour of the adrenal cortex, non functioning and normally asymptomatic, which can be diagnosed by chance in imaging test. Rupture and bleeding of the myelolipoma is an infrequent complication, which can conclude with the formation of a haematoma or, less usually, result in a massive retroperitoneal haemorrhage. The compression of adjacent structures by retroperitoneal haematomas with adrenal origin is a possible but not frequent eventuality. Indications for surgery of haematoma retroperitoneal continue to be, nowadays, a difficult and controversial decision, because the problem is normally resolved with conservative treatment and a watchful approach. We are presented with a 69 year old male who came to casualty with abdominal pain of 7 days duration, whose origin coincided with a light blow. The image test revealed the existence of a retroperitoneal haematoma with adrenal gland origin of 16 cm, with active bleeding, which was displaced and compressed the cava vein. We have only found one case, in the literature, of compression of the cava vein coused by adrenal gland haematoma. In the case under our observation, urgent surgery was needed.

[Validation of ESCAP-CD as an instrument of measure for the evaluation of the quality of life in prostatic cancer. Part 2a]. / Validación del ESCAP-CDV como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. 2a Parte.

UNLABELLED: In order to make a measure of quality of life related to health (QLRH) useful in the investigation, it must fulfill the psychometric properties (validity, reliability and sensibility). The selection of an instrument is a job for the clinic that must choose the most effective for each proposed objective. We set out the objectives to validate the ESCAP-CDV in a multicentric study in Andalusia. We studied 88 patients who were submitted to the instrument presented to validation and two more tests recognized already: the QLQ-C30 from EORTC gold standard in Europe in the valuation of the neoplastic patients' quality of life and the KARNOFSKY the most clinic utility index in neoplastic patients, used to correlate the items. RESULTS: Questionnaire acceptance analysis: The difficulty of understanding was greater for QLQ C30 items (6.81%) than ESCAP items (1.98%). The lapse of time needed to carry out the test was shorter in the ESCAP test (9.84 min) than in the QLQ C30 (13.13), test. Structural analysis or internal validity analysis: The homogeneity index of the items is high (alfa of Cronbach = 0.93). The dimensionality proposed is not accepted, due to the existence of some modifications pund in the factorial analysis. Finally, the established dimensions: Physical and Emotional Capacity (PEC), 5 items; General Symptoms (GS), 4 items; Pain (P), 3 items; Ligh Functional Capcity (LFC), 4 items; Serious Functional Capacity (SFC), 2 items; Economic State (ES), 3 items; Social and Family State (SFE), 5 items; Capacity Sexual (CSX), 2 items; Isolated Variables (IV), 2 items; and Specific Questionnaire (P), 6 items. The ESCAP is a scale with a normal distribution. Approach or external validity analysis: The ESCAP test is well correlated with the other two scales. Reliability test retest: The interclass correlation coefficient is 0.94 in the ESCAP, not so in the KARNOFSKY that is 0.77. CONCLUSIONS: The ESCAP-CDV is a new instrument of valuation of the QLRH composed of a general questionnaire and other specific test of prostate cancer. It has turned out to be a very homogeneous scale due to its internal consistence (alfa of Cronbach of 0.93), showing that it has a normal distribution, that correlates correctly with the scales compared and it is a valid scale to measure the prostate cancer patients' quality of life. The ESCAP-CDV has shown to be a scale with a high reliability (0.94), setting up as an instrument not only useful for investigation, but to clinical use, as well.

[Development of the ESCAP-CDV as measuring tool for the assessment of quality of life in prostatic cancer]. / Desarrollo del ESCAP-CDV como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. Primera parte.

The current following of oncological patients is based in a biopsychosocial model where in addition to evaluate the response to treatment, the interval free of illness and the global survival it includes the functional capacity and the psychosocial charge the illness causes in patients. Nowadays, different treatments have improved the survival, therefore the number of years of inability increase. It creates a new variable, the quality of life related to health (QLRH) that valves the individual respond to the physical, mental and social effects that health or illness produces on patients daily life. To establish the QLRH as an instrument of measure is needed. In Spain there isn't any validated instrument for the evaluation of it in patients with prostate cancer. We have developed the ESCAP-CDV (Quality of Life study on prostate cancer) an instrument elaborated by an interdisciplinary group made of urologist, psichologists and a doctor specialized in family medicine expert in psychometric validation of scales. We evaluate multiple dimensions of quality of life in a questionnaires autoadministed.

[Radical prostatectomy or radiotherapy? A qualitative structured review]. / Prostatectomía radical o radioterapia? Una revisión estructurada cualitativa.

We performed a structured literature review to define de effectiveness of radical prostatectomy and external radiotherapy for treatment of localized prostate cancer. We identified 463 articles in MEDLINE for January 1990 through april 2000. As judged from our analysis, prostatectomy radical has marginal benefit in terms of supervivency and disease free respect to external radiotherapy with the same quality of life.

[Renal cancer: descriptive analysis of a series of 267 intervened cases]. / Cáncer renal: análisis descriptivo de una serie de 267 casos intervenidos.

OBJECTIVE: To present the results of a descriptive analysis of 267 surgically treated renal tumors. METHODS: From January 1986 to October 1999, 267 patients (153 males and 114 females) with renal tumor were treated in our department. All data were introduced into the Access data base program and analyzed using the SPSS software. Descriptive analysis was performed and life expectancy was calculated with the Kaplan-Meier survival curve. Mean follow-up was 42.72 months. RESULTS: 56.4% were in the right and 43.6% were in the left kidney. 41.2% of the cases were incidentally discovered. In the symptomatic patients, the most common presenting feature was hematuria (51.8%). Radical nephrectomy was performed in 94.2%, partial in 3.1% and tumor resection in 2.7%. The lumbar approach was used in 75.5% of the cases. In regard to the histology, 88.7% were carcinomas. Clear cell was the most frequent cell type (91.5%). By grade, 55.8% were GI, 32.9% GII and 11.3% were GIII. By stage (according to the 1992 TNM classification), 64.3% were stage I, 15.4% stage II, 17% stage III and 3.3% stage IV. 80.5% showed no vascular involvement. The 5-year overall survival was 71.93% (mean 114 months; median 167 months). Currently, 76% of the patients are alive. CONCLUSIONS: Distribution by sex in our series was different to that reported in most of the studies. The tumor was incidentally discovered in a high proportion of the cases. The lumbar access was the most widely used surgical approach. The overall survival is similar to that reported by other groups.

[Fibroepithelial polyp of the urethra in a young woman]. / Pólipo fibroepitelial de uretra en mujer joven.

OBJECTIVE: We present the case of a fibroepithelial polyp from the uretra of a young female, analysing the factors that make this an interesting case. MATERIAL AND METHODS: A case-report of a fibrous polyp from the urethra of a young female, an analysis of its differential diagnosis and a review of the literature. RESULTS AND CONCLUSIONS: The fibrous polyp of the urethra (fibroepithelual polyp, simple polyp, pedunculated polyp) is a rare benign epithelial tumour, more frequently encountered in males and in the posterior urethra. When it appears in females it is usually located in the external meatus and normally asymptomatic, although it can also present with a mictional syndrome, terminal hematuria or urethral hemorrhage. The differential diagnosis includes other benign epithelial tumours of the urethra, such as the caruncula, mainly the granulomatous, very difficult to differentiate, the squamous papilloma and the acuminated chondiloma. A clinical examination and histological study are necessary for a correct diagnosis, and treatment consists of surgical resection.

[Urinary incontinence caused by urocolpos. Report of a new case]. / Incontinencia urinaria por urocolpos. Aportación de un nuevo caso.

We present a new case of urocolpos that appeared as urinary incontinence. We discuss the etiology and the available therapeutic choices, emphasizing on the value of the clinical history and physical exploration showed data.

[Value of post-miction residue after urethrocervicopexy. Prospective study]. / Valor del residuo posmiccional tras la uretrocervicopexia. Estudio prospectivo.

OBJECTIVE: To demonstrate that a high post-micturitional residue after a colposuspension is not a success predictive factor in the incontinence surgery. METHODS: We designed two identical groups of work, with the only difference of a high post-micturitional residue in one of them after the surgery (< 100 cc), and we evaluated the surgical results, with a follow-up of one year. We considered fails the presence of losses related with stress. RESULTS: There were no significative differences in the number of the deliveries, age, weight, length or body mass index in both groups. There were significative differences in the permanence of the urethral catheter and residue of urine, p < 0.001. There were no differences in the number of success in both groups. CONCLUSION: A high post-micturitional residue after colposuspension is not an influent factor in the final result of surgery.

[Urethrocervicopexy in aged women. Prospective study]. / Uretrocervicopexia en la mujer mayor. Un estudio prospectivo.

OBJECTIVES: [corrected] To demonstrate that Burch colposuspension gives a higher index of fails in over sixty years women affected of stress incontinence than in women under sixty years of age. METHODS: We established two groups of follow-up, each of them included twenty women affected of stress urine incontinence and surgical treatment indication. The only difference between both groups was the age of the patients, with a limit established in sixty years. We have evaluated the results of surgical intervention one year after it. The binomial parameters are compared with x2 test; the continuous parameters with the t-Student test for independent parameters. RESULTS: We did not find statistical significative differences with number of deliveries, body mass index, previous pelvic surgery, perineal rehabilitation, or the importance of the incontinence, between both groups of women. We found statistical significative difference in the novo micturition urgency or an increase in a previous urgency (p < 0.1) in women over sixty years. We did not find statistical significative differences in the number of successes and fails in both groups. CONCLUSION: The age is not a risk factor of failing of Burch colposuspension, but it is a risk factor of the appearance or increase of micturition urgency.

[Nephrogenic adenoma. Report of 4 new cases]. / Adenoma nefrogénico. Presentación de cuatro nuevos casos.

OBJECTIVE: Four additional cases of nephrogenic adenoma are described. METHODS: The clinical records of patients with nephrogenic adenoma that had been diagnosed at our hospital from 1994 to 1999 were reviewed. RESULTS: The most frequent localization was the urinary bladder and it was more prevalent in middle-aged men. This condition usually presented as a histological finding in the course of follow-up or treatment of other bladder conditions by TUR or cystectomy. Biopsy is fundamental for diagnosis. CONCLUSIONS: Nephrogenic adenoma is a rare benign metaplastic lesion of the urinary tract that appears to result from chronic irritative stimulus to the urothelium. The treatment of choice is by transurethral resection. Although no case of progression to malignancy have been detected, long-term follow-up by endoscopy and ultrasound is advocated due to its predispositon to recurrence.

[Tumor excision in renal oncocytoma: report of a new case]. / Tumorectomía por oncocitoma renal: aportación de un nuevo caso.

OBJECTIVE: To describe a case of renal oncocytoma that was treated by conservative surgery. METHODS: Herein we describe a 55-year-old patient with a preoperative suspicion of left renal oncytoma based on the findings of punction-aspiration biopsy and CT. The patient underwent tumor resection. RESULTS/CONCLUSIONS: Oncocytomas can present typical radiological features. Conservative surgery is a treatment option in carefully selected patients that usually achieves good results.

[The webbed penis. A report of a new case]. / Pene membranoso. Aportación de un nuevo caso.

OBJECTIVE: To report an additional case of webbed penis or penis palmatus, an uncommon malformation caused by alterations that occur during the embryonic development of the external genitalia. METHODS: A 15-year-old by consulted for penile curvature. He was diagnosed as having webbed penis and phimosis, and was submitted to surgery. RESULTS/CONCLUSIONS: Z-plasty and circumcision achieved excellent results. He had no erectile anomalies following surgery.