[A new pathology: unstable urinary bladder (author's transl)]. / Una nueva patología: la vejiga inestable.

Thirty-five cases of incontinence of urine due to hyperactivity of the detrusor as a result of unstable urinary bladder were found among 100 patients with incontinence. The cause of the hyperactivity was established after a thorough urological and neurological screening with intravenous urography, seriated mictional cystoureterography, cystoscopy, and urine culture. The diagnosis was considered definite if uninhibited contractions of the detrusor were detected by electrocystomanometry. The primary clinical symptom was an imperious urge to mi-turate, with or without leakage of urine. Diurnal and nocturnal frequency was exacerbated in cold weather and in contact with water. There were some instances of a history of late enuresis and association with cystoceles. Anticholinergics (propantheline bromide) are the treatment of choice. Surgery should be indicated only after all medical attempts have failed.

[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.

[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.

[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.

[Primary retroperitoneal hydatidosis]. / Hidatidosis retroperitoneal primaria.

Genitourinary involvement by the Echinococcus granulosus larvae (urinary hydatidosis) ranks third in order of frequency after liver and lung involvement. The finding of a primary hydatidic cyst with retroperitoneal location is an uncommon fact. This paper presents once case of this infrequent disease. A revision of the different etiopathogenic mechanisms, as well as diagnostic and therapeutic approaches is made.

[Cervico-urethro-suspension by the Raz's technique in the treatment of stress urinary incontinence in women]. / Cervicouretrosuspensión según técnica de Raz en el tratamiento de la incontinencia urinaria de esfuerzo en la mujer.

Presentation of our results in the treatment of urinary exertional incontinence in women using Raz's cervicourethral suspension. From January 1991 through December 1995, 87 patients were operated (mean age: 55.64 years; range 36-74). Mean follow-up was 29.4 months. Recovery from incontinence or permanence of minimal occasional leaks due to major exertion were rated as good results and were achieved in 75 cases (86.20%). Percentage of success in patients with mild incontinence was 93.33%; 88.88% in moderate incontinence; and 58.33% in severe incontinence, differences being statistically significant (p < 0.01). No statistical significance was found relative to age, prior incontinence corrective surgery, hysterectomy or association with urgency incontinence. Prior to surgery, 21 patients also had a component of urgency incontinence which disappeared post-surgery in 18 (85.71%) cases. De novo urgency incontinence appeared in 4 (6.06%) cases. Complications seen were 3 vesical perforations (3.44%). 1 urethrovaginal perforation (1.15%), 2 enterocele (3.44%) and 24 patients with transient urinary retention (27.58%). We believe this technique offers long-term successful results with a moderate morbidity rate.

[Retroperitoneal cystic mass. Giant exophytic gastric leiomyosarcoma]. / Masa quística retroperitoneal. Leiomiosarcoma gastrico exofítico gigante.

Presentation of an unusual case of pre-operatively non-striated retroperitoneal cystic mass confirmed to be a gastric leiomyosarcoma after pathoanatomical study. Considering the rarity of the case, we reviewed the literature as well as the epidemiological, clinical, pathoanatomical and surgical characteristics of gastric leiomyosarcomas which, as in the present case, can appear as retroperitoneal mass.

[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.

[Rigid ureteroscopy. Results and complications]. / Ureteroscopia rígida. Resultados y complicaciones.

Analysis of results and complications of retrograde rigid ureterorenoscopies (URS) performed in our unit between August 1985 and June 1990. Our series includes 122 URS performed in 106 patients: 68% female and 32% male. A rigid ureteroscopy Storz 11.5 Ch was used. URS indications were: 72% treatment of ureteral lithiasis, 14% diagnosis, 7% treatment of ureteral tumores and 3% other reasons. Treated lithiasis were predominantly located in the pelvic ureter. Overall success in the treatment of lithiasis was 92.86% in "primary" lithiasis, and 71.43% in post-ESWL. URS allowed us to resolve troubles of differential diagnosis in 93.75% of cases. With a complications rate of 19.7%, only 3.28% were considered relevant.

[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.

[Camey II type substitution ileocystoplasty. Our experience]. / Ileocistoplastia de sustitución tipo Camey II. Nuestra experiencia.

We present our experience in the performance of Camey II type substitution ileocystoplasty. The operation was performed between January 1988 and February 1989 on 11 patients who had been diagnosed as having vesical tumour by means of transurethral resection. All of them had received preoperative systemic chemotherapy. Technically, we single out the performance of ileo-obturating lymphadenectomy prior to the cystoprostatovesiculectomy in the same operation, creation of the neobladder with detubulized terminal ileum, uretero-ileal reimplantation according to Le Duc-Camey technique and use of mechanical sutures to reestablish intestinal continuity. Operative and postoperative mortality has been null. As complications, we may mention a urthro-ileal fistula as a result of the suture tension at this level, due to shortness of the mesointestine, and which yielded with conservative measures. Amongst tardive complications we may single out a urethro-ileal stenosis, which required performance of an internal urethrotomy. Daytime continence in all patients, except one. Night continence in six cases. Absence of ureteral reflux and upper urinary tract with correct function and morphology in all cases. The follow-up time ranges from 3 to 16 months. We conclude that this type of vesical substitution offers all patients a good quality of living and adequate mictional comfort.

[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.

[Therapeutic effectiveness and safety of prazosin in the symptomatic treatment of benign prostatic hypertrophy]. / Eficacia y seguridad terapéuticas de prazosin en el tratamiento sintomático de la hipertrofia prostática benigna.

74 patients diagnosed as suffering from benign prostatic hypertrophy (BPH) were treated with prazosin for 8 weeks. We look at the evolution of the symptomatology and the urodynamic and morphologic parameters during the treatment and they are compared with the basal ones. The irritative symptoms (nocturia, pollakiuria, imperiosity and dysuria), evaluated by means of a quantitative scale, undergo significant statistical improvement. The same occurred with the obstructive symptoms. Urodynamically, an increase took place in total vesical capacity, maximum, and mean flow, as well as a drop or reduction in non-inhibited contractions. 27 patients suffered adverse effects, which obliged 8 of them to abandon the treatment. Global efficacy was excellent in 20% and good in 52%, whilst it was fair and ineffective in 19 and 9%, respectively.

[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.

[Treatment of ureteral stenosis complicated by endourethral prosthesis. Long-term results]. / Tratamiento de las estenosis uretrales complicadas con prótesis endouretrales. Resultados a largo plazo.

OBJECTIVE: To evaluate the long-term results obtained in the treatment of urethral stenosis complicated with urethral endoprosthesis. MATERIAL AND METHODS: Between March 1991 and December 1996, 40 endourethral prosthesis were implanted in 36 patients; 2 prosthesis were placed in 4 patients. Of the 40 prosthesis implanted, 37 were UroLume and 3 Ultraflex. All, with the exception of 2, were patients with recurrent stenosis after earlier failures of prior internal urethrotomy and/or repeat urethral dilations. RESULTS: Immediate post-operative symptomatic relief was achieved in 97.2% patients. Only one patient required removal of the endoprosthesis. In 4 patients (11.1%) urethral restenosis develop distal or proximal to the endoprosthesis. No patient developed restenosis due to endoprosthetic fibrosis. CONCLUSIONS: The long-term results obtained in the treatment of bulbar urethral stenosis complicated with endoprosthesis demonstrate the efficacy and stability over time of this technique, which shows a low complications rate when patients are strictly selected.

[Retroperitoneal fibrosis caused by pancreatitis in an HIV+ patient]. / Fibrosis retroperitoneal por pancreatitis en paciente VIH+.

Retroperitoneal fibrosis is a rare inflammatory disease, in which the fibrosis plate leads to the compression of the affected structures. There are several causes of retroperitoneal fibrosis like specific and unspecific inflammatory diseases. In the specific group of retroperitoneal fibrosis we find the one due to pancreatitis. We do present a rare case of retroperitoneal fibrosis caused by a pancreatitis in a HIV+ patient.

[Biochemical evaluation of renal lesions produced by electrohydraulic shock waves]. / Evaluation biochimique des lésions rénales produites par les ondes de choc électrohydrauliques.

The authors present a biochemical study of the renal lesions produced during extracorporeal electrohydraulic shock wave lithotripsy (ESWL). The sequential variation (before and after ESWL) of various biochemical parameters of the blood and 24-hour urine was analysed in 50 patients. A significant increase of urinary N-Acetyl-Glucosaminidase (NAG), urinary NAG/urinary creatinine quotient, proteinuria, serum creatinine and potassium was detected during the 24 hours following ESWL. A significant fall in creatinine clearance, urinary osmolarity and uric acid clearance was also detected. A positive correlation was observed between these alterations, the number of shocks and the kilovoltage used. On the 7th and 15th days, no significant difference was observed compared to the baseline values before ESWL. This can be explained by the fact that the lesions caused by shock waves are already in the repair phase.

[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.

[Angiomyolipoma of the kidney with lymphatic involvement]. / Angiomiolipoma renal con afectación ganglionar.

We present a case of renal angiomyolipoma associated with tuberous sclerosis affecting the regional lymphatic ganglia. We analyse the possible etiopathogenesis of this affection and conclude, like most authors, that it may reflect the multifocalization of this tumour rather than malignity or metastatic lesion.