Prolapso de uretra y retención urinaria postembolización prostática. A propósito de un caso / Urethral prolapse and urinary retention post- prostatic embolization. About a case

Introducción y Objetivos: Entre las complicaciones de la embolización prostática figuran el ardor miccional, la infección urinaria, la hematuria, la rectorragia, la retención urinaria, la balanitis y la hemospermia, pero hasta la fecha no se había comunicado el prolapso uretral, una patología exclusiva del sexo femenino en la especie humana, a diferencia de otras especies vertebradas donde sólo afecta a los machos.El objetivo de esta comunicación es presentar el primer caso de prolapso uretral en un varóntras haberle practicado una embolización de las arterias prostáticas como tratamiento de su hiperplasia prostática benigna.(AU)

Background and Objectives: Complications of prostatic embolization include voiding pain, urinary tract infection, hematuria, rectal bleeding, urinary retention, balanitis and hemospermia, but to date no urethral prolapse in man has been reported , being an exclusive pathology of the female sex in the human species, unlike other vertebrate species where it only affects males. The aim of this report is to present the first case of urethral prolapse in a male after having performed an embolization of the prostatic arteries to treat his benign prostatic hyperplasia.(AU)

Cristaluria masiva asociada a infección urinaria ureolítica: un caso exepcional / Massive crystalluria associated whit ureolitic urynary infection: an exceptional

Introducción y Objetivos. Las infecciones urinarias por gérmenes ureolíticos se asocian generalmente con la eliminación y/o formación de cálculos infectivos de estruvita (fosfato amónico magnésico, fosfato triple). Sin embargo no tenemos conocimiento de que se haya comunicado ningún caso de emisión masiva de cristales con visualización macroscópica y recuperación de las arenillas en el "poso seco" del sedimento de la orina. El objetivo de este breve artículo es comunicar un infrecuente caso de cristaluria masiva de fosfato amónico magnésico secundaria a infección urinaria por la asociación de dos gérmenes: Citrobacter freundii (no ureolítico) y Morganella morgagnii (ureolítica). Caso Clínico. Mujer de 72 años sin antecedentes urológicos previos que consultó por presentar desde hace 1 año expulsión de gran cantidad de arenillas en las micciones, hasta el punto de que en alguna ocasión le ocluían momentáneamente la uretra. La paciente aportó una muestra de la cristaluria (arenilla) recuperada del poso seco del sedimento de su orina, donde se aprecia un gran volumen de polvo y arena (microcristales). El estudio del sedimento urinario mostró PH 8, densidad de 1035 (n 1005-1030), nitritos (+), bacteriuria y abundante cantidad de cristales incoloros en forma de prisma o "ataúd" sugestivos de corresponder a cristales de fosfato amónico magnésico. En el urinocultivo existían 500.000 UFC/ml y se aislaron 2 gérmenes uno no ureolítico (Citrobacter freundii) y otro ureolítico (Morganella morgagnii). Radiografía simple de aparato urinario y ecografía normales. El análisis químico de la arenilla mostró una composición de 80 por ciento fosfato amónico magnésico y 20 por ciento oxalato cálcico. Se instauró tratamiento según antibiograma con ciprofloxacino 500 mg cada 12 horas 7 días y se acidificó la orina con vitamina C (ácido ascórbico) 500 mg día 20 días, consiguiendo erradicar la infección urinaria, normalizar el PH urinario a 5, y frenar definitivamente la expulsión de cristales. En un control a los 6 meses permanecía asintomática y con urinocultivo estéril. Conclusiónes. Este caso es una forma de presentación excepcional de una infección urinaria ureolítica, sin los síntomas clásicos habituales. Su única manifestación clínica fue la expulsión de gran cantidad de cristales (arenilla) en las micciones que en ocasiones provocaban obstrucciones intermitentes de uretra de resolución espontánea. Este singular caso demuestra que escuchando a los pacientes, a veces nos cuentan hechos casi imposibles y la mayoría de las veces son verídicos (AU)

Background and Objetives. Ureolytic urinary tract infections are generally associated with the elimination and / or formation of struvite infective stones (magnesium ammonium phosphate, triple phosphate). However, we are not aware of any reports of massive emission of crystals with macroscopic visualization and recovery of the sand in the "dry" sediment of the urine. The objective of this brief article is to report an infrequent case of massive crystalluria of magnesium ammonium phosphate secondary to urinary infection due to the association of two germs: Citrobacter freundii (non ureolytic) and Morganella morgagnii (ureolytic). Clinical Case. A 72-year-old woman with no prior urological history who consulted for the past 1 year of expulsion of a large amount of sand in the micturition, to the point that she had occasion ally occluded the urethra. The patient provided a sample of the crystalluria (sand) recovered from the dry sediment of her urine, where a large volume of dust and sand (microcrystals) was seen. The study of the urine sediment showed PH 8, density of 1035 (n 1005-1030), nitrites (+), bacteriuria and abundant amount of colorless crystals in the form of prism or "coffin" suggestive of corresponding magnesium ammonium phosphate crystals. In the urinoculture there were 500,000 CFU / ml and two non-ureolytic (Citrobacter freundii) and one ureolytic (Morganella morgagnii) were isolated. Simple x-ray of normal urinary system and ultrasound. The chemical analysis of the grit showed a composition of 80 pertcent magnesium ammonium phosphate and 20 pertcent calcium oxalate. Therapy was initiated according to antibiogram with ciprofloxacin 500 mg every 12 hours 7 days and the urine was acidified with vitamin C (ascorbic acid) 500 mg day 20, succeeding in eradicating the urinary tract infection, normalizing the urinary pH to 5, and finally stopping expulsion Of crystals. In a control at 6 months, he remained asymptomatic and with sterile urine culture. Conclusions. This case is an exceptional presentation of a urethritic urinary infection, without the usual classic symptoms. Its only clinical manifestation was the expulsion of large amounts of crystals (sand) in micturitions that occasionally caused intermittent urethral obstructions of spontaneous resolution. This unique case demonstrates that listening to patients, sometimes tell us almost impossible facts and most of the time are true.(AU)

Absceso renal estafilocócico trasforunculosis cutánea / Staphylococcus renal abscess after cutaneous furunculosis

Los abscesos renales son patologías infrecuentes, pero de alta morbi-mortalidad si no son diagnosticados temprano y tratados precozmente. Su vaga e inespecífica sintomatología: dolor abdominal o lumbar, fiebre o mal estado general hacen que su diagnostico sea a veces tardío. La ecografía y/o la TAC dan el diagnóstico en el 100 por ciento de los casos lo que hace posible su tratamiento temprano. El objetivo de este artículo es poner de relieve que el absceso renal es una causa de urgencia urológica a tener presente en pacientes fundamentalmente del sexo femenino, con síntomas de dolor abdominal o fiebre sin clara focalidad urológica.MATERIAL Y MÉTODOS: Se presenta el caso de una adolescente de 16 años con antecedente reciente de forunculosis cutánea supurada en rodilla derecha, que acudió a urgencias por dolor en flanco derecho y fosa iliaca derecha de 10 días de evolución sin fiebre ni síntomas miccionales. Se nos consultó para su valoración, siendo la ecografía el método diagnóstico que se utilizó para la localización de un absceso renal derecho subcapsular de 44 mm en polo superior, y posteriormente para su drenaje percutáneo al no responder porcompleto al tratamiento antibiótico i.v. El cultivo del material purulento del drenaje percutáneo aisló un Staphyloccocus aureus no meticilin resistente. El tratamiento antibiótico i.v asociado a drenaje percutáneo seguido de cloxacilina oral a su alta, curó a la paciente. A raíz de este caso se revisan las series y revisiones sobre abscesos renales de los últimos 10 años, con un total de 179 pacientes, y las publicaciones sobre abscesos renales por Staphyloccocus aureus con tan sólo 13 casos. CONCLUSIONES: Los abscesos renales han de tenerse en cuenta entre las urgencias urológicas. Su diagnóstico y tratamiento percutáneo es mayormente radiológico, reservándose la cirugía abierta o la nefrectomía para abscesos > de 5 cm o pacientes sépticos...

Renal abscesses are infrequent pathologies, but with a high morbidity-mortality if they are not diagnosed and treated early. Its vague and unspecific symptomatology: abdominal or lumbar pain, fever or poor general state, make its diagnosis late sometimes. The ultrasound and/or TAC provide a 100 percent diagnosis of the cases where its early treatment is possible. The objective of this article is to give importance to the fact that renal abscess is a cause of an urological emergency to keep in mind in patients, particularly females with symptoms of abdominal pain or fever without a clear urological focus. MATERIAL AND METHODS: The case of a 16-year-old adolescent is presented with a recent history of festered cutaneous furunculosis on the right knee. She went to the emergency room due to pain on the right side and right illiac fosa with 10 days evolution without fever or urinary symptoms. She came to us for its evaluation, an ultrasound was used for diagnosis to locate a right subcapsular renal abscess of 44 mm on the superior pole, and later for its percutaneous drainage when it did not completely responded to I.V. antibiotic treatment. The culture of the purulent material of the percutaneous drainage isolated a resistant non-methicillin Staphyloccocus aureus. The I.V. antibiotic treatment associated to percutaneous drainage followed by oral cloxacillin upon release cured the patient. CONCLUSIONS: Renal abscesses have to be taken into account among the urological emergencies. Their diagnosis and percutaneous treatment is mainly radiological, leaving open surgery or nephrectomy for abscesses > 5cm or with septic patients...

Cálculo gigante enclavado en meato uretral femenino: resolución en área de urgencias / Giant calculus located in the female urethral meatus: resolution in an emergency setting

Objetivo: Comunicar un caso inusual de cálculo uretral femenino gigante enclavado en meato, que debutó por sangrado genital, sin retención urinaria ni síntomas miccionales. El cálculo era visible en el introito. Se efectuó tratamiento resolutivo en el área de urgencias, cursándose el alta a las pocas horas. Métodos: Se presenta el caso de una paciente de 82 años, con antecedentes remotos de cirugía vesical, que acudió a urgencias por sangrado genital. Valorada por Ginecología se apreció un gran cálculo uretral que a¬ oraba por el meato, derivándose a Urología. Tras la exploración física se solicitó radiografía simple de pelvis donde se apreció un gran calculo uretral de 6 x 4 cm. Bajo anestesia local se practicó meatotomía inferior con luxación y extracción del cálculo; siendo dada de alta a continuación con sonda vesical hasta la cicatrización de la herida. Resultados: La evolución tras el “parto del cálculo” fue favorable. Se cursó el alta con sonda vesical a las pocas horas de la extracción litiásica. Acudió nuevamente a urgencias 12 horas más tarde por arrancamiento involuntario de la sonda, siendo nuevamente sondada y dada de alta. La evolución posterior fue favorable, retirándose la sonda y conservando la micción espontanea. Conclusiones: El síntoma de sangrado genital femenino, no siempre se corresponde con problemas ginecológicos. La patología de la uretra femenina también puede ser su responsable: carúnculas, prolapsos, divertículos, quistes parauretrales de Skene, estenosis o cálculos como el caso presentado. Casos como éste pueden ser resueltos en la propia área de urgencias con relativa facilidad y sin necesidad de ingreso hospitalario.

Objective: To communicate the unusual case of a giant female urethral calculus located in the meatus, which presented with genital bleeding, without urinary retention or voiding symptoms. The calculus was visible at the introitus. Resolving treatment was performed in the emergency setting, progressing to discharge in a few hours. Methods: The case involved an 82–year-old patient with a remote history of bladder surgery who came to the emergency room with genital bleeding. On evaluation by the Gynecology staff, a large urethral calculus was found in the meatus, and a referral was made to the Urology department. After a physical examination, simple radiographs of the pelvis were ordered, in which a large urethral calculus (6 × 4 cm) was identified. Under local anesthesia, an inferior meatotomy was performed with luxation and extraction of the calculus; the patient was discharged with a catheter that was left in place until the wound healed. Results: The evolution after the “birth” of the calculus was favorable. The patient was discharged with a catheter a few hours after extraction of the lith. She returned to the emergency setting 12 hours later after inadvertently pulling out the catheter and was recatheterized and discharged. The patient’s later evolution was favorable; after removing the catheter, she maintained spontaneous voiding. Conclusions: The symptom of female genital bleeding does not always correspond to gynecological problems. Female urethral pathology can also be responsible; caruncles, prolapses, diverticuli, paraurethral cysts of the Skene’s gland, stenosis, or calculi, as in the case presented, can all result in bleeding. Cases like this one can be resolved in the emergency department relatively simply and without necessitating an inpatient admission.

[Vasectomy: study of 300 interventions. Review of the national literature and of its complications]. / La vasectomía: estudio de 300 intervenciones. Revisión de la literatura nacional y de sus complicaciones.

OBJECTIVES: The aims of this paper are: 1. To study the demand and reasons why of the vasectomy in area 12 of Valencian Community. 2. To analyse the adverse effects of our series and the predictable risk factors. 3. To review the adverse effects in the national series. 4. To review the adverse effects referred to in international publications. PATIENTS AND METHODS: A retrospective study was made of 300 patients who had submitted themselves to a vasectomy between january 1992 and december 2000. All the clinical dossiers were reviewed according to 10 pre-established variables. age, number of offspring, reasons why, pre-vasectomy anticontraceptives; date of operation, type of anaesthesia used, pathologic anatomy, semen analysis after vasectomy, adverse effects and their possible causes (risk factors). The basic statistic study was done using a data base of Microsoft Access and the interpretations of the different variables using a table of Excel. RESULTS: The demand for contraceptive attention (vasectomy) is the 8th cause for external urological consulting and the 4th for urological local ambulatory surgery of our area. 300 operations were done during that period. The average age of the patients was 37.5 years old (ranging from 25 to 51). The number of offspring ranged from 1 to 7, with a promedia of 2.41 children/patient. The reasons why were: voluntary family planning (86%), medical illnesses of the female which contraindicated gestation (9%), genetic reasons (4.33%) and social-sanitary problems (0.66%). Contraceptive methods used by 71.63% are known: The widest-used method being IUD (49.74%) and the preservative (25.88%). 30 patients (10%) had adverse effects, 29 patients having light adverse effects. The most frequent were: 12 orchiepididymitis (4%), 5 spermatic granulomas (1.66%), 3 chronic scrotal pain (1%), 2 scrotal haematoma (0.66%) and 2 bleeding (0.66%). There was one serious complications and of all the cases mentioned above only one needed hospitalization (impetigo-sepsis) and another needed surgery due to a spermatic granuloma. There were no pregnancies or post-vasectomy court cases. 81% of the patients had been declared azoospermic within 45 to 60 days after the vasectomy in one or two consecutive semen analysis. CONCLUSIONS: The vasectomy is a safe and simple way for male sterilization. It's the most widely done urologic operation in Spain. The technique isn't extent of adverse effects (0 to 18%) and its seriousness varies from a simple ecchymosis to Fournier's gangrene, endocarditis or sepsis. A doctor would be considered negligent if he/she didn't inform the patient about the remote possibility of a spontaneous recanalisation of the vas deferens leading to renewed fertility (failure of the vasectomy). It is imperative to give post-vasectomy information where the patient must continue using his habitual anticonceptive method until the azoospermia shown in 2 semen analysis confirm the sterility of the patient so that the urologist has no legal problem.

[Transitional carcinoma of the ureter and ipsilateral synchronous renal cell carcinoma in hydronephrotic atrophic kidney: infrequent association]. / Carcinoma transicional de uréter y carcinoma ipsilateral sincrónico de células renales en riñón atrófico hidronefrótico: asociación infrecuente.

We report a new case of simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma into ipsilateral ureter. A review of the literature to date indicates this is the 45 world-wide case and the 8 in the Spanish publications.

[Sclerotherapy of hydrocele and cord cyst with polidocanol. Efficiency study]. / Escleroterapia del hidrocele y quiste de cordón con polidocanol. Estudio de eficiencia.

OBJECTIVES: Checking the efficiency (cost/benefit) of the sclerotherapy with polidocanol in our country for the treatment of hydrocele and epididymal cyst. PATIENT AND METHODS: We studies 86 patients with this diagnosis from may of 1995, until april of 2000. We have applied the costs for process according to the indicators of administration-cost our hospital in the year 1999. OUTPUTS: 79 patient completed the protocol. The overall cure rate was 83.87% with sclerotherapy; 42.3% with first one treatment. Only a 4.5% of the patients had significant pain and a 7.4% others complications. DISCUSSION: There were necessaries 1.5 sclerotherapies of mean for curation, resulting this treatment 4.78 more cheaper than surgery. CONCLUSION: The sclerotherapy with polidocanol of the hydrocele or epididymal cyst are an effective treatment, sure, simple, reasonably comfortable and fundamentally, economical.

[Significance of simple radiography of the abdomen in nephritic colic]. / El valor de la radiología simple de abdomen en el cólico nefrítico.

BASIS: The utility of the abdominal plain film in the emergency department to evaluate urolithiasis is questionable. Between another things, there are influence of the different formation of distinct examinators. METHODS: A retrospective study in 65 patients referrals to urology in 1997 and 1998 by suspicion of renal colic was carried out. The radiography of abdomen took in the emergency room the day of the income is reviewed with a protocol, by a resident of Familiar and Community Medicine and by the urologist, separately and without information of the medical records. RESULTS: We have excluded three patients. At last, we diagnose 49 patients as renal colic with certainty, 6 patients with doubtful diagnosis and 7 patients with distinct diagnosis. The urologist achieved the most adequate reading in 11 cases; in 7 was best the resident, to equal in 31, and in 13 the differences were not important. The resident obtained of radiography a sensitivity of the 67% and a specificity of the 42% and the urologist 71% and 57% respectively. CONCLUSIONS: There are few differences of reading, at least when the resident dispose a protocol of interpretation. Despite to the almost null diagnostic utility of the radiography, supply additional ation, and permit to value the evolution with a few aggressive technique.

[Acute scrotum without technology]. / El escroto agudo sin tecnología.

The highly developed diagnostic technologies of our time applied to acute scrotum is not readily available in many of our hospitals. With the purpose of evaluating our results in the diagnosis and treatment of this nosologic entity, and to compare them with those reported by other hospitals where modern technologies are being used, our group revised all patients referring this condition who were given emergency treatment by the urologist on call during the first 100 months of our unit. An analysis is made of the etiology, patient's age, disease location, time of evolution, diagnosis, treatment received and final outcome. The epidemiological data obtained is similar to other series published, except for the hydatid torsion, which was more frequent than previously reported. In cord's torsion, a similar background should be considered a poor prognostic factor. In summary, the left testicle is more exposed to the various acute scrotal diseases. Surgery is an attractive option for hydatid torsion. Finally, an earlier intervention in the event of suspicious cord torsion remains the most important factor in the prognosis. Our results, using no state-of-the-art diagnostic technologies, are similar to other series and we see no trend towards unnecessary surgical examination.

[Primary epidermoid carcinoma of the renal pelvis]. / Carcinoma epidermoide primitivo de pelvis renal.

Epidermoid carcinomas account for 9 to 17% of primitive pyelocaliceal tumours. Key predisposing factor are infections and lithiasis, pre-operative diagnosis being difficult due to insidious growth and absence of pathognomonic syndrome. The paper introduces one case of epidermoid pyelocaliceal carcinoma where diagnosis was supported by intravenous urography, ultrasound and CAT, and where the catheter-obtained cytology was definite in terms of diagnostic value. Ureteropyeloscopy can be a crucial examination in case of diagnostic doubt. Choice therapy is nephroureterectomy with vesical collar resection when the tumour's anatomical state or the subtotal nephrectomy allow it. Prognosis of these tumours is very poor, mean survival of patients being of about 4 months. Our patient died one month after surgery.

[Acute scrotal hematoma in Schoenlein-Henoch purpura. Infrequent urologic manifestation]. / Hematoma escrotal agudo en la púrpura de Schönlein-Henoch. Manifestación urológica infrecuente.

Schönlein-Henoch purple is a systemic vasculitis due to hypersensitivity. It is typical of childhood and more unusual in adults. The etiology is unknown. It is identified by the presence of skin purpura, joint involvement, abdominal colic pain and quite often renal involvement (nephropathy). Urological manifestations are uncommon and include: haematuria, scrotal swelling, cord haematoma, signs and symptoms mimicking cord or hydatid torsion, testicular pain due to intratesticular segmented infarction, painful ecchymotic induration of the scrotum, or testicular necrosis. Contribution of one case of Schönlein-Henoch purpura developed in adulthood with scrotal-perineal haematoma associated to skin purpura and abdominal colic pain in a 75-year old patient.

[Complications of the lower urinary tract secondary to urethral stenosis]. / Complicaciones del tracto urinario inferior secundarias a estenosis uretral.

Among the complications from urethral stenosis those derived from obstructive uropathy of the lower urinary tract and genitalia should be pointed out for their high frequency, the low attention they are given and their potential seriousness. Such complications are related to urinary infection and favoured by the anatomical and functional changes stenosis causes on urinary and genital organs. This paper analyzes the complications in the lower urinary tract in a group of 175 male patients with urethral stenosis, diagnosed at the General Teaching Hospital in Alicante between January 1977 and January 1990. 154 complications of the lower urinary tract (LUT) were reported in 124 patients (71%) out of the initial 175. In 86 patients (49%) these complications were isolated, whereas in 38 patients (22%) they coexisted with other in the genitalia. Frequency ranking of LUT complications was: fight bladder (68% patients), vesical diverticulosis (19%), chronic prostatitis (13%), megabladder (10%), vesical lithiasis (6%), urethral lithiasis (4%), urethral diverticulum (4%) and chronic periurethritis (2%). Renal failure developed in 25 patients (20%), and progressed to CRI in 3 (2%). Urinary infection occurred in 59 (48%) patients, primarily by urolithic germs (24%). Management of the 124 urethral stenosis required a total of 159 procedures, but only 20 (13%) of the 154 complications required surgery. We conclude that patients with urethral stenosis have frequent LUT complications, and that long-term male stenosis associated to urinary infection is a risk factor. Surgery tends to be the preferred treatment option for both stenosis and some of the complications.

[Epididymal adenomatoid tumor. Review of the national literature and report of a case]. / Tumor adenomatoide de epidídimo. Revisión de la literatura nacional y aportación de un caso.

Benign epididymal epithelial tumours are very uncommon. Their frequency rating is as follows: adenomatoid tumour, leiomyoma and papilliferous cystoadenoma. This paper contributes a new case of epididymal adenomatoid tumour in a 29-year old male who presented with testicular pain. Diagnosis was achieved through physical examination and echography. A simple tumourectomy was performed. As a result of this case, a review was made of the Spanish literature.

[Adrenal myelolipoma. Report of a case and review of the literature]. / Mielolipoma suprarrenal. Aportación de un caso y revisión de la literatura.

OBJECTIVES: Herein we describe an additional case of myelolipoma of the adrenal gland, an uncommon tumor of the adrenal cortex, that had been incidentally discovered during abdominal US evaluation of the biliary tree. The clinical features, diagnosis and treatment of the condition are discussed. METHODS: Surgical treatment of the biliary tree and myelolipoma was performed through a Chevron transversal incision during the same surgical session. RESULTS: Surgery achieved good results and the postoperative course was unremarkable. CONCLUSIONS: Myelolipoma is a benign nonfunctioning tumor of the adrenal cortex comprised of adipose and hematopoietic tissue. It is usually asymptomatic and incidentally discovered during diagnostic evaluation for other pathologies. The diagnosis is made by US, CT and MRI. There is no agreement on whether surgical treatment is warranted.

[Lumbago-sciatica syndrome as the first manifestation of metastatic renal adenocarcinoma]. / Síndrome de lumbociática como primera manifestación de un adenocarcinoma renal metastásico.

Presentation of one case of metastatic renal adenocarcinoma with iliac bone and soft parts involvement which presented as a lumbosciatic picture. A comment is made on the different diseases which can result in painful lumbar syndrome, reaching an agreement on the need to conduct more extensive studies given the lack of response to standard medical treatment.

[Adipose retroperitoneal tumors. Apropos a giant myxoid liposarcoma]. / Tumores adiposos retroperitoneales. A propósito de un liposarcoma mixoide gigante.

Liposarcomas are the most frequent retroperitoneal tumours, second only to lymphomas. We present a new case of giant retroperitoneal liposarcoma treated in our hospital. A discussion is presented on the most peculiar aspects of this tumour, such us: multicentricity, tendency to local relapse, and need to post-operative (adjuvant) radiotherapy. A review of all nationwide cases over the last few years is included.

[Epidemiology of urethral stenosis in the province of Alicante]. / Epidemiología de la estenosis uretral en la provincia de Alicante.

Urethral stenosis is the most frequently acquired disease of the male urethra. Currently there is a progressive increase of this condition's occurrence due to: improved living standard, increased number of permanent catheter bearers, surge of STDs incidence, and abuse of transurethral diagnostic or therapeutical instrumentation. However, and in spite of such increased incidence, the epidemiological features have been forgotten by most authors consulted who now focus more attention in the therapeutical aspects. This paper analyzes the most outstanding epidemiological aspects, in the province of Alicante, of 180 urethral stenosis corresponding to 175 males and 5 females, making some final considerations on the relevance of certain factors in the genesis of urethral stenosis: advanced age, depressed social class, active sexual life, STD history, urinary or genital infections.

[Renal and ureteral complications of urethral stenosis]. / Complicaciones renales y ureterales de la estenosis uretral.

This paper analyzes the renal and ureteral complications caused by urethral stenosis. A total of 180 patients with stenosis, 175 males and 5 females, were reviewed. There were 55 renal-ureteral complications in 37 patients (20.55%). In order of frequency, complications were as follows: renal failure (36%), ureterohydronephrosis (33%), chronic pyelonephritis (16%), vesico-ureteral reflux (11%), and post-obstructive renal annulment (4%). Most complications were reversible. However, renal function impairment was irreversible in 3 cases due to I.R.C., as well as in 2 cases due to post-obstructive renal atrophy-annulment. Nine patients showed chronic pyelonephritis morphological changes. Urinary infection occurred in 28 patients (76%), and in 50% of them was due to ureolytic germs. The best procedure to treat these complications is based on a correct prevention, eradicating the associated urinary infection and correcting the causative obstructive problem. Nonetheless, surgery was required in 5 patients (13.50%) and extracorporeal lithotripsy for the lithiasis associated to stenosis in other 5 patients (13.50%). We conclude that although those complications have a high incidence, their ultrasound diagnosis is easy and the prognosis reversible once the stenosis is corrected. Risk factors for development are: male sex, the sixth decade of life and a long evolution stenosis associated to urinary infection. Finally, a review of the scarce literature on this frequent but forgotten chapter of obstructive uropathy is made.