[Usefulness of renal resistive index in the diagnosis and evolution of the obstructive uropathy. Experimental study]. / Utilidad del indice de resistencia renal en la valoración y evolución de la uropatía obstructiva. Estudio experimental.

OBJECTIVE: The study was focused on determining the effectiveness and reliability of using the renal resistance index as a method of diagnosing and monitoring the evolution of obstructive uropathy treatment. For this purpose, we conducted an experimental study on a homogenous group of animals that all had the same level of obstruction. MATERIAL AND METHODS: 15 healthy female pigs were used. The experiment was divided into three phases: phase I consisted of a study prior to unilateral pyeloureteral junction obstruction, performing retrograde ureteropyelography, renal B-mode ultrasound and duplex-Doppler (of both kidneys) at a level of the arcuate arteries. Then, the obstruction was performed on the animals. Phase II commenced by diagnosing the lesion, 6 weeks after the previous phase, by means of the aforementioned diagnostic methods. Finally, the endourological treatment was completed. Animals were monitored (Phase III) 15 weeks after the endopyelotomy, using the same methods as in the study, by assessing the urinary tract (fluoroscopy) and both kidneys by determining the renal resistance index and ratio. RESULTS: All the animals in the study showed signs of urinary obstruction on radiology and renal ultrasound 6 weeks after ureteral ligature. After treatment and follow-up, all animals showed signs of having recovered from the obstructive uropathy. Values of deltaRI during the 3 phases are detailed below. Fase I deltaIR = 0.01, Fase II deltaIR = 0.11, Fase III deltaIR = 0.02. CONCLUSION: RI determination using duplex-Doppler is effective for distinguishing obstructive dilatation using non-invasive techniques. However, this parameter provides very slight differences and it can also be influenced by too many direct and indirect factors (observational, patient age, anaesthesia, haemodynamic parameters, etc.), to supplant the classic diagnostic methods.

[Endourologic treatment of ureteral strictures. Experimental comparative study]. / Tratamiento endourológico de estenosis ureterales. Estudio experimental comparativo.

OBJECTIVES: To compare efficacy and efficiency of two different endourological therapies for ureteral stricture, and to evaluate pathological reactions of the ureters following both endourological techniques. MATERIAL AND METHODS: Ten pigs underwent experimental induction of ureteral stricture. Four weeks later, ureteral strictures were demonstrated by imaging techniques. Animals were divided in two groups, according to the received therapy: -Group I. (5 pigs), endoballoon rupture endoureterotomy. -Group II (5 pigs), Acucise balloon endoureterotomy. Ureteral stents were placed for 3 weeks following endoureterotomy. Animals were followed up four weeks after ureteral stents retrieval. RESULTS: In all cases, ureteral stricture was proved four weeks after model induction. In one case from each group, it was needed a second balloon dilatation to achieve complete endoureterotomy. Leading to ureteral restenosis, stent migration occurred in one animal from group I. Success was achieved in 80% of cases from group I, and 100% of cases from group II. CONCLUSIONS: Our results suggest that both endourological therapies are effective. Nevertheless, a higher efficiency was proved with Acucise endoureterotomy. Our pathological evidences do not support Davis's studies on ureteral healing following endoureterotomy.

[Current indications for laparoscopic surgery in urology]. / Indicaciones actuales de cirugía laparoscópica en urología.

More than four years have elapsed since the first laparoscopic pelvian lymphadenectomy for the staging of prostate cancer was performed. The early impact of the procedure involved the broadening and gradual application of laparoscopy to the group of organs and diseases of our specialty, mainly with therapeutical purposes. Urologists are able to reproduce nowadays many of the traditional surgical procedures through these methods. The present paper tries to conduct an update of the different techniques applied up to now on the different structures (genitalia, prostate, bladder, ureter, kidney, adrenals, pelvian nodes and other) and to analyze objectively some specific indications based on the experience gathered by several authors and our own.

Laparoscopic pelvic lymphadenectomy for prostatic cancer.

Development of laparoscopic techniques has converted lymphadenectomy into a real alternative to current laparotomy technique. The limitation of diagnostic imaging methods to know ganglion involvement in prostate cancer as well the high incidence of false negatives in frozen intrasurgical biopsies following open-surgery lymphadenectomy has pushed us since november of 1990 to develop laparoscopic lymphadenectomy with staging. This study analyses the diverse diagnostic imaging methods and continues with a precise description of the laparoscopic technique. The authors summarize the results of our series and finish the article with a review of the most controversial aspects as well as the diagnostic value, advantages and disadvantages with respect to open surgery techniques, complications and indications of this technique at the present moment.

[Laparoscopic nephrectomy: a case report]. / Nefrectomía laparoscópica: caso report.

Presentation and clinical picture outline of a patient who underwent transperitoneal laparoscopy-assisted nephrectomy. The procedure lasted 4 hours and the patient was discharged 72 hours later without incidence or complications. The paper describes the technique (presently unique and for selective indications), as well as the resources that the extensive laparoscopic experience of our group put into practice to perform the first successful laparoscopic nephrectomy in humans in our country.

[Endoscopic internal urethrotomy guided with transrectal echography]. / Uretrotomía interna endoscópica dirigida por ecografía transrectal.

Internal urethrotomy is the endoscopic technique most commonly performed in order to resolve urethral stenosis. This paper describes a new technique which associates transrectal ultrasound to internal endoscopic urethrotomy for the resolution of unsurmountable stenosis of the urethra. Presentation of 6 cases, with a 100% success rate. The authors believe that the association of transrectal ultrasound with internal endoscopic urethrotomy is a simple technique, and very useful for the resolution of unsurmountable stenosis of the urethra.

[Endoscopic ureteral resection in radical nephroureterectomy: report of our experience]. / Desinserción ureteral endoscópica en la nefroureterectomía radical: presentación de nuestra experiencia.

We want to present our clinic and chirurgical experience in eight patients, using the radical nephroureterectomy with endoscopical resection of the ureter, as a safe and valid technique, in urothelial tumours localized in the upper urinary tract.

[Urethral amyloidosis]. / Amiloidosis localizada de la uretra.

Localized amyloidosis of the urethra is a rare pathological entity. Biopsy is required to make the appropriate diagnosis. Although localized therapy is available for obstructing, symptomatic lesions, asymptomatic lesions may be followed with conservative management and spontaneous regression has been reported. An appropriate medical evaluation should be performed to determine the presence of systemic amyloidosis.

[Excretory azoospermia secondary to a cyst of the seminal vesicle]. / Azoospermia excretora secundaria a quiste de vesícula seminal.

A case report of malformation of the right mesonephric ductus, involving a seminal vesicle cyst and ipsilateral renal and ureteral agenesis. The infrequency of such pathology is recalled and the oddity, in our case, of its presentation in the fashion of infertility secondary to excretory azoospermia highlighted. The deferentovesiculography, ultrasound scanning, urography and CAT were highly illustrative in the diagnosis. The treatment of choice in symptomatic cases is surgical exeresis, which in our patient secured the resolution of the azoospermia.

[Laparoscopic lymphadenectomy for lymphatic staging in prostatic cancer: preliminary experience]. / Linfadenectomía laparoscópica para estadiaje ganglionar en cáncer prostático: experiencia inicial.

The current diagnostic methods, primarily transrectal ultrasound scanning (supported with ultrasound-directed biopsy), CAT and tumoral markers, allow an earlier and more reliable diagnosis of prostatic neoplasias. The chances of diagnosing these tumours while in low stages (A, B, and C without affecting the seminal vesicle) imply a higher indication for radical surgery (prostatectomy) with an intention to cure. However, the prognosis and therefore the indication will be determined by the presence of regional nodular affectation. Imaging diagnostic methods (lymphography, CAR, NMR) have been proven incapable of providing an acceptable degree of diagnostic safety, therefore staging lymphadenectomy continues to be mandatory. Laparoscopic lymphadenectomy allows to meet requirements of surgical radicality comparable to those of traditional open surgery while showing an irrefutable decrease of morbidity and being more convenient for the patient. Our early experience with this surgical technique of staging in prostatic neoplastic pathology is illustrated.

[Value of CAT staging in renal adenocarcinoma. Correlation with anatomo-pathologic findings]. / Valor del estadiaje del TAC en el adenocarcinoma renal. Correlación con los hallazgos anatomo-patológicos.

On a total of 128 renal adenocarcinomas diagnosed in our Unit between January 1975 and August 1990, the data provided by CATs carried out in 85 of them was compared with that from surgical and anatomo-pathological findings. The precision in both the diagnosis and the tumour staging was determined, evaluating the involvement of perirenal, nodular, venous and neighbouring structures fat. The diagnosis of renal adenocarcinoma was made correctly in 96% cases. With regard to staging, maximal precision was achieved in the involvement of adjacent structures and vena cava, followed by the renal vein, perirenal fat and lymphatic nodes, in this order. We conclude that CAT provides a high diagnostic reliability, permitting with a single study the determination of the most defining parameters of renal cancer staging.

[Laparoscopic ureterolithectomy. A new option]. / Ureterolitectomía laparoscópica. Un nuevo recurso.

An integral conception of patients with various diseases can benefit from the contemporary technological developments which allow to differentiated non-invasive approaches as diagnostic and therapeutical resources. This kind of patient has allowed further development of laparoscopic surgery in urology derived from the addition of reported conditions: obstructive prostate carcinoma, juxta-vesical gross lithiasis imbedded for 2 years, complexity of ureteroscopic access, large volume for extracorporeal lithotripsy and the need to know the extend of nodular affectation.

[The early diagnosis of prostate cancer in a selected population. The usefulness of PSAD, PSAD ad. and age-adjusted PSA in patients with a PSA between 4-10 ngr./ml]. / Diagnóstico precoz del cáncer de próstata en población seleccionada. Utilidad del PSAD, PSAD ad. Y PSA ajustado a la edad en pacientes con PSA entre 4-10 ngr./ml.

RATIONALE: Exposition of our experience in the early diagnosis of prostate cancer, based on the initial selection of patients. METHODS: Evaluation of patients from within the area covered by our hospital and seen for signs and symptoms of prostatism. Those with suspicion rectal examination (RE) or PSA greater than 4 ng/ml were further evaluated with transrectal ultrasound and prostate biopsy. RESULTS: Based on the biopsies of 700 patients, prostate carcinoma was diagnosed in 294/700 (42%). 55.72% patients with suspicion RE, and 47.5% with PSA > 4 had cancer. In patients with PSA > 4 and non-suspicion RE, cancer was detected in 16.44%. The percentage of neoplasia in patients with PSA 4-10 ng/ml and non-suspicion RE was 10%. As a result of these findings, 88 radical prostatectomies were performed. PASD and PASD ad. showed significant differences between patients with and without cancer, whether with (+)RE (p = 0.0001) or (-)RE (p < 0.0004), unlike PSA that showed no differences. The diagnostic value shown by PSAD ad. in ROC curves was similar to that of PSAD. Value of age-adjusted PSA was not higher than PSAD. CONCLUSION: Performance of prostate biopsy with a suspicion RE is recommended. If RE shows no suspicion, biopsy should be performed when PSA is > 10 ng/ml, and with PSA 4-10 ng/ml a biopsy is advocated with PSAD > 0.15.

[Value and sequence of the biopsy of the seminal vesicles and laparoscopic pelvic lymphadenectomy in the staging of cancer of the prostate]. / Valor y secuencia de la biopsia de vesículas seminales y la linfadenectomía pelviana laparoscopica en el estadiaje del cáncer de próstata.

OBJECTIVE: To establish the current indication in our milieu of seminal vesicles (s.v.) biopsy and laparoscopic pelvic lymphadenectomy in prostate cancer. MATERIAL AND METHODS: The prospective study of s.v. biopsy includes 128 patients. Overall efficacy of the technical procedure, incidence of seminal infiltration in relation to clinical staging, PSA, Gleason or the association of both are all analyzed. The second part of the project involves a retrospective statistical study applied to the lymphadenectomy series over a period of 10 years on 202 cases (69 laparoscopic and 133 open ceiling), analyzing several risk factors for nodular invasion. RESULTS: Seminal and nodular infiltration was related to clinical stage, PSA and Gleason. PSA > 20 and Gleason > or = 7 is clinically the most useful association for the diagnosis of seminal infiltration. Increased PSA and Gleason involved greater nodular infiltration; the optimal cut-off point is 40 and 7 respectively. CONCLUSIONS: S.V. biopsy should be performed in T3 stage or in earlier stages with PSA greater or equal to 20 and/or Gleason greater or equal to 7. If biopsy is tumour negative, laparoscopic lymphadenectomy should be performed at T3 stage (regardless of PSA or Gleason), and in < T3 with PSA greater or equal to 40, Gleason greater or equal to 8 and when Gleason is 7 and PSA > 20.

[Quality of life after radical prostatectomy]. / Calidad de vida tras prostatectomía radical.

OBJECTIVE: To evaluate the quality of life of our prostatectomized patients relative to the following factors: continence, mictional quality, sexual potency and psychological repercussion. MATERIAL AND METHODS: The study includes a series of 204 patients undergoing radical prostatectomy between June 1986 and October 1996, where a personal questionnaire was administered to 112 of them. The questionnaire consisted of 25 questions dealing with various aspects related to their quality of life. RESULTS: The overall rating on continence shows the following results: total continence 59.8%, minimal incontinence grade I 17.8%, moderate incontinence grade II 13.3% and total incontinence grade III 8%. Only 2.6% retains sexual potency after surgery. 29.3% of impotent patients consulted for their dysfunction. 91% declared to be satisfied with the results of the surgical procedure. CONCLUSIONS: In our experience, continence (total + grade I incontinence) is acceptable for 77.6%, the level of mictional satisfaction being very high. There is a high index of impotence after surgery. However, most patients appear to be impervious to this fact. Overall, quality of life of our patients has not changed significantly as a result of the intervention.

[Urethral nephrogenic adenoma in a young male. Report of a case]. / Adenoma nefrogénico uretral en varón joven. Aportación de un caso.

Nephrogenic adenoma is a rare urothelial neoformation. It is well known the association to infective diseases and stones; the most common localization is in the bladder. We report the case of a young male without previous disease who showed a nephrogenic adenoma in the urethra, it was managed with transurethral resection and surveillance.

[Tumor recurrence in the resected area of the ureteral meatus after endoscopic disinsertion during radical nephroureterectomy]. / Recidiva tumoral en la zona de resección del meato ureteral tras desinserción endoscópica en la nefroureterectomía radical.

The endoscopical resection of the urether in the radical nephroureterectomy is an easy way to treat transitional cell carcinoma of the upper urinary tract. We want to present a complication derived from this surgical technique: the tumor implantation in the resected ureteral meatus zone.

[Laparoscopic diagnosis of Hodgkin's disease. Report of a case]. / Diagnóstico mediante laparoscopia de enfermedad de Hodgkin. A propósito de un caso.

Laparoscopic Surgery with diagnosis objectives in Urology, has many others indications related with different medical specialties, apart from the ones for the urologic area (ectopic test, linfadenectomy, etc...). In our case, the Services of Urology and Hematology, diagnosed a Hodgkin's disease case. The Service of Hematology realized treatment and evolution. Sometimes, the unspecific clinical presentations of the Hodgkin's disease, shows adenopatics masses, detected by Ecografy or TAC. Treatment and prognosis of the Hodgkin's disease, are related with the histological subtype and its spreading.

Laparoscopic pelvic lymphadenectomy in the staging of prostate cancer.

Lymphadenectomy provides sufficiently accurate information for the efficient staging of prostatic carcinoma. This paper provides a step-by-step guide to laparoscopic lymphadenectomy, based on the authors' experiences. Clinical staging of patients with neoplastic node involvement was also documented. Laparoscopic lymphadenectomy was found to be a highly efficient method for nodal staging of pelvic neoplastic pathology, similar to that reported in conventional surgery. The mean number of nodes obtained per case was determined to be 11.2. Of the 35 cases in which laparoscopic lymphadenectomy was performed, node involvement was evident in 23%, all of whom were negative by computerized tomography scan. Laparoscopic lymphadenectomy was concluded to be a minimally invasive surgical procedure, associated with few complications and a short hospital stay.