[Incrusted cystitis after Mitomicin-C]. / Cistitis incrustante tras Mitomicina C.

Incrusted cystitis is an infrequent process characterized by precipitation an incrustation of salts on the vesical mucosa. An alkanine urine is required to this precipitation. The urinary infection with urolithic activity microorganisms can also be a very important factor. We present a case of incrusted cystitis after using Mitomicine as vesical chemotherapy.

[Self-administered questionnaire for assessing the Raz technique in stress urinary incontinence: analysis of results]. / Un cuestionario de diseño propio para la evaluación de la técnica de Raz en la incontinencia urinaria de esfuerzo: análisis de resultados.

OBJECTIVES: Knowing our results in the treatment of the stress incontinence by means of the use of the Raz technique evaluated by sending a questionnaire. MATERIAL AND METHODS: From July 1995 until the 31st of December 1998, 137 patients were operated by the Raz technique. The 102 people who were monitored for over 12 months were sent a questionnaire asking them about the postoperative evolution and the degree of the satisfaction obtained. From the 78 (76.47%) people who answered, 75 were included in this study with an average age of 53.96 and an average follow-up of 27.12 months. RESULTS: Thirty patients (40%) showed the disappearance of their stress incontinence, seventeen patients (22.7%), an important improvement and ten (13.3%) a slight improvement, but only 58.20% of the patients were very or quite pleased with the results. None of the preoperatives variables analysed showed any meaningful influence in the outcome, while the longest time of persistence of postmiccional residue was shown as a factor of prediction in a better result. CONCLUSIONS: The mediocre results and the low rate of satisfaction got with this technique justifies the research of other therapeutic and more effective options.

[Fecundity following prepubertal orchiopexy in unilateral cryptorchism. Experimental study]. / Fertilidad tras orquidopexia prepuberal en la criptorquidia unilateral. Estudio experimental.

Study of fecundation ability following unilateral experimental cryptorchism as a function of the timing of orchiopexy. Two groups of 45 Wistar rats underwent unilateral mechanical cryptorchism and early and late prepuberal posterior orchyopexy, respectively. A third group of 45 rats underwent a dummy intervention. Mating taking place in subgroups of 15 animals at different ages showed that in the experimental animal, and therefore in any non-dysgenetic test, orchiopexy performed at the prepuberal period allows preservation of fecundation ability.

[Scrotal digestion caused by pancreatic ascites]. / Digestión escrotal por ascitis pancreática.

One case of scrotal necrosis during acute necro-haemorrhagic pancreatitis. A histological study of the resected tissue demonstrated presence of fatty digestion caused by the pancreatic fluid. Discussion of the etiological possibilities, including a review of the relevant literature.

[Double-J catheter: spontaneous rupture]. / Catéter doble J: rotura espóntanea.

A case is presented of spontaneous rupture of a double-J catheter in a 61-year-old patient suffering from carcinoma of the prostate gland with urethral entrapment. The patient did not attend visits for periodical catheter changes, suffering the rupture of the catheter in two occasions remaining under those conditions for 20 and 18 months respectively. Removal of the fragments and placing of a new double Pit-Tail, required in both occasions a combination of cystoscopic and percutaneous maneuvers.

[Urethrocystopexy with bone anchors: technical modification]. / Uretrocistopexia con anclajes óseos: modificación técnica.

OBJECTIVE: To communicate a technical modification of urethrocystopexy which consist in the suspension of the urethropelvic ligaments to the posterior pubic bone with using bone fixations inserted with the In-Fast system. MATERIAL AND METHODS: Between August 2000 and January 2001, thirteen patients with an mean age of 56.1 years were operated with this technic. Using a transvaginal approach and after great opening of the endopelvic fascia we insert one fixation screw in each side of the symphisis pubic bone, later we give two or three stitches to the urethropelvic ligament with the polypropylene no. 1 suture that each screw have joined to their end. RESULTS: The mean stay has been 5.1 days. The cystostomy has been remained for a mean of the 10.1 days. We didn't observe any complication neither intra nor postoperatives. With a mean follow-up of 5.3 months all the patients present a disappearance of their stress incontinence. CONCLUSIONS: Lack of confirm with a larger following and more cases, the suspension of the urethropelvisc ligaments with screw fixations directly situated into the pubic bone per vaginal approach, has been a simple method, safe and highly comfortable for the patients.

[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.

[Non-radical treatment and bladder conservation in infiltrating tumor of the bladder]. / Tratamiento no radical y conservación vesical para el tumor infiltrante de vejiga.

The fate of some infiltrant tumours of the bladder locally advanced (pT2-3NxM0) which were radically resected, with or without association to other treatments, has been similar to those in which initial radical treated was used. To carry out simultaneously a radical RTU as a local action plus systemic chemotherapy (M-VAC), for microscopic metastasis, clinically undetected, seems to us the most effective combination. In our Urology Unit, the evolution (September 88-January 91) of 9 patients presenting this tumour and preservation of the bladder is being followed-up. The primary tumour was treated with radical RTU in 7 cases and partial cystectomy in 2. There are 5 tP2, 1 pT2 + "in situ" carcinoma (Ca) and 3 pT3, 4 G1, 4 G2 and 1 G3. All tumours were single, small (2-4 cm), with varied location and nearly all with medium to low differentiation. Later all patients underwent systemic chemotherapy with M-VAC (3 cycles). Following RTU and QMT every three months, the likely local and systemic progression of the disease has been evaluated through cystoscopy and multiple biopsies including from the prostatic urethra, RTU of anterior scar, two-hand palpation, urinary cytology, blood testing, CAT, abdominal ECO, chest X-ray and laparoscopic lymphadenectomy (coinciding with its development within the Unit) in the last case. Average follow-up (at the time of the review) has been 15.77 months (6-28 months).(ABSTRACT TRUNCATED AT 250 WORDS)

[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.

[Trigono-cervico-prostatic incision]. / Incisión trígono-cérvico-prostática.

Trigone-cervico-prostatic incision is a surgical alternative in the treatment of urinary obstruction induced by small size prostate. Twenty-three patients were treated in our unit with this procedure, 17 because they were carriers of small size prostate and 6 because they were high risk surgical patients in which the simplicity and swiftness of this technique were essential. Good results have been obtained both clinical and in urological flow in 95.7% cases. The only complication was one stenosis of the urethra requiring internal urethrotomy but there were no cases of vesical cervix contracture or urinary incontinence. Average follow-up was 12.5 months. It is concluded that this is a valid, low morbidity alternative that can be offered to patients with small sized and symptomatic prostate.

[Current validity of urethroplasty in two stages]. / Vigencia actual de la uretroplastia en dos tiempos.

Review of 18 patients with complex urethral stenosis, who underwent a two-stage urethroplasty in our Unit over the last three years. Clinical results have been favourable in all patients and, from the radiological point of view, there has been only one re-stenosis. Complications rate has been low and can be superimposed to that of any urethroplasty procedure. The paper emphasizes the enormous relevance of the care taken between both surgical stages on the procedure's final result.

[Systemic candidiasis and ureteral fungus ball. Ketoconazole and irrigating solutions in the management of urinary candidiasis]. / Candidiasis sistémica y fungus ball ureteral. Ketoconazol y soluciones irrigantes en el manejo de la candidiasis urinaria.

A case of systemic candidiasis is presented in a patient with one kidney in the post-operative period from a cysto-prostatouretrectomy with Bricker ureteroileal derivation, performed due to multifocal superficial vesical tumour non controllable by endoscopy. The clinical picture developed with anuria and temporary diuresis periods associated to a severe septic picture; a deep Candida albicans infection was demonstrated by laboratory tests and a fungus ball ureteral obstruction was demonstrated by radiology. Urinary derivation by means of percutaneous nephrostomy, associated with oral treatment with ketoconazole and local treatment with amphotericin B solution intermittently irrigated through the nephrostomy allowed the patient's resuperation and the fungus ball was spontaneously ejected after 30 days of treatment. The different forms of presentation of urinary candidiasis are discussed together with the diagnostic methods and present therapeutical options, with special reference to the imidazole derivative ketoconazole and irrigation solutions.

[Metastasizing kidney cancer. Experience with interferon alfa-2a and vinblastine]. / Cáncer metastásico de riñón. Experiencia con interferón alpha-2a y vimblastina.

Management of renal cells carcinoma still remains a therapeutic challenge. Nephrectomy is the primary therapy when the disease has a definite location. In advanced or disseminated cases, the various traditional procedures, including radiotherapy, chemotherapy or hormonal regimes, have obtained poor responses. Survival shows a direct relationship with the biological aggressiveness of the tumour and histological factors. Results recorded in the literature using specific immunotherapeutic agents are encouraging although the real value of this regimes has not yet been established in large series of prospective studies. The Oncology Unit of our Urology Service has obtained optimal follow-up in a group of patients included in a combined protocol of interferon alpha-2a and vinblastine as cytotoxic agent.

[Growing teratoma syndrome]. / Síndrome del teratoma en crecimiento.

Appearance of residual masses following chemotherapy of retroperitoneal metastasis from testicle's non-seminomatous germinal cell tumour does not always imply we are facing an active tumoral disease. When exeresis of these masses discovers the presence of a mature teratoma during the histological study, what we have is the so called Growing Teratoma Syndrome. Such teratoma is unresponsive to chemotherapy but the patient can be cured by means of a full exeresis of the residual mass, thus the relevance of having into account the likelihood of this pathology. The paper presents the case of a patient with retroperitoneal non-seminomatous testicle tumour and metastasis which, following chemotherapy, presented a residual mass with normal serological markers. After the exeresis it was found out that it was made up by mature teratoma. Four months after rescue surgery, the patient remains asymptomatic, has normal markers and no signs of neoplastic recurrence.

[Emphysematous cystitis]. / Cistitis enfisematosa.

We present a new case of emphysematous cystitis, commenting on some of the more interesting aspects of the etiopatogeny diagnosis and treatment of this entity. We underline the importance of early diagnosis and effective treatment of the disease as well as of the coadjuvant factors.

[Cavernous hemangioma of the penis]. / Hemangioma cavernoso de pene.

We report one case of cavernous hemangioma of penis shaft appeared in a 35 years old man like a painful mass. The blood analysis and radiologics examinations hadn't any important contribution to the diagnostic that, finally, was confirmed during the surgical extirpation and the posterior histological study. We make a brief description about the mentioned pathology.

[Bladder adenocarcinoma of urachal origin. A rare tumor]. / Adenocarcinoma vesical de orígen uracal. Un raro tumor.

With the description of this new case of urachal adenocarcinoma in the vesical cupula we provide a review on the clinical, pathological and immunohistochemical aspects of this rare tumour, as well as a diagnostic and therapeutical approach. Its subepithelial infiltrant nature delays discovery and denotes both an insidious evolution and poor prognosis. Mucinoid production, nodes pattern and certain immunohistochemical substances as well as abnormalities in the cell's DNA content are attributes of this entity. Only surgery, either partial or exeresis, is effective since this is a radioresistant and dubiously chemosensitive tumour.

[Incoercible hemorrhagic cystitis induced by pelvic radiotherapy and simultaneous treatment with cyclophosphamide]. / Cistitis hemorrágica incoercible inducida por la radioterapia pelviana y tratamiento simultáneo con ciclofosfamida.

We present a case of incoercible hemorrhagic cystitis provoked by the therapeutic association of systemic cyclophosphamide and pelvic radiotherapy in a woman with disseminated mammary carcinoma disease. The conservative treatment, including vesical irrigation with aluminum salts, did not succeed in stopping the bleeding. A "sauvatage" cystectomy was carried out with Bricher-Wallace II type urinary derivation. We conclude by pointing out how the simultaneity of two therapies with individual vesical toxicity risk were boosted and how cystectomy continues to be the definitive treatment once conservative measures have been used up.

[Parotid metastasis of renal adenocarcinoma: report of a case]. / Metástasis parotidea de adenocarcinoma renal: a propósito de un caso.

Renal adenocarcinomas are tumours which sometimes tend to remain clinically silent, and initially become evident through distant metastasis. This paper presents the case of a 54 year-old patient whose initial clinical evidence was parotid metastasis from kidney clear cells adenocarcinoma. The patient had a metastasis and renal tumour exeresis with application of supplementary chemotherapy and immunotherapy, presenting early pulmonary metastasis which remains currently unchangeable. Some comments apropos of distant metastasis, its prognosis and regression in renal tumours are made.