[Overview of urethral strictures: etiology, epidemiology, physiopathology and classification. General principles of urethral repair]. / Aspectos generales de la estenosis uretral: etiología, epidemiología, fisiopatología, clasificación. Principios generales de la reparación uretral.

In this article we present the causes of urethral stenosis in the adult male and review data about incidence. Regarding disease physiopathology we emphasize the inflammatory causes and, more specifically lichen sclerosus, as the clinical scenario that presents the greater difficulty for the management of urethral stenosis since we do not know its natural evolution. Regarding treatment of urethral stenosis we discuss the various options from excision and terminal-terminal anastomosis to oral mucosal graft augmentation urethroplasty, passing by two-step operations in more severe cases. Looking forward to the future a real gate opens with the application of tissue engineering to obtain oral mucosa.

[Patient with testosterone deficit syndrome and dyslipemia]. / Paciente con SDT y dislipemia.

We define dyslipemia as the abnormally elevated presence of lipids in the blood. The main ones are hypercholesterolemia (cholesterol over 240 mg/dl), hypertrigliceridemia (triglicerides level over 200 mg/dl) and hipo-alphalipoproteinemia (High density lipoproteins,also called HDL Cholesterol, below 40 mg/dl). The presence of excessive lipids contributes to arteriosclerosis and they are an independent cardiovascular risk factor. It may be primary, if they have genetic origin and they are not associated with other diseases, but in most cases they are secondary to other pathological entities such as diabetes, hypothyroidism, obesity and metabolic syndrome (MS). In our current society, sedentary lifestyle and unadequatelly hypercaloric diets are making obesity and MS prevalences grow, and their relation to dyslipemias has become tighter. Obesity is related with all the criteria for MS. But obesity is not at all synonymous of MS. On the one hand neither fat distribution is the same in all individualas nor confers the same risk. Accordingly, we know that abdominal localization of fat is related to higher intensity of insulin resistance (IR) and MS. On the other hand, it seems that certain components of MS are determined by genetic factors, since there are morbid obese persons that are metabolically healthy and other patients develop insulin resistance without obesity. So that, it seems that the excess in visceral adiposity in the presence of certain genetic factors would be the most related cause of the appearance of peripheral insulin resistance and diabetes mellitus, hyperlipidemia (increase of very low density pipoproteins (VLDL), decrease of highdensity lipoproteins (HDL) arterial hypertension, and hypogonadotropic hypogonadism, composing what we call metabolic syndrome. In this scenario, we urologists are being first-hand witnesses.On the one hand, and in relation with cardiovascular risk factors, we know that all of them, and independently,not only can produce erectile dysfunction due to endothelial dysfunction, but also it generally appears years before the cardiovascular event. On the other hand, and in relation to the hypogonadotropic hypogonadism of patients with MS, we urologists may contributein greatly to the detection of patients with MS whose only symptom is erectile dysfunction or diminished libido, but specially we may play a key role in the improvement of these patients, since it is known that testosterone replacement therapy has a major potential to diminish or stop the progression of MS or its cardiovascular effects. Testosterone treatment not only improves the lipid profile, hypertension, insulin resistance, or reduces the abdominal circumference, but also it may help to get a better adherence to diet and exercise, so contributing to change unhealthy lifestyle habits whch are the origin of the problem.

[Renal mass biopsy: results and safety in 2009]. / Biopsia de masas renales: resultados y seguridad en 2009.

The role of renal mass biopsies has been limited by suboptimal results in terms of diagnostic reliability, and their scant repercussion upon therapeutic decision taking. Recently, however, renal mass biopsies have generated renewed interest among urologists, as a result of the increased incidence of renal tumors, the introduction of new management options, and advances in histological diagnosis. A review has been made, based on a PubMed search of the most relevant publications on renal tumor biopsies in recent years. The most recent clinical studies reveal a high degree of diagnostic reliability in differentiating malignancy, histological type and grade in percutaneous biopsies of renal tumors, with a low rate of associated complications. However, routine use of the technique remains controversial, and its indications limited, due to the scant capacity of the renal biopsy findings to modify treatment decision.

[Photoselective vaporization of the prostate with Laser Greenlight HPS: current role, technical aspects and review of the literature]. / Papel actual de la fotovaporización prostática con Láser Greenlight HPS. Aspectos técnicos y revisión de la literatura.

Photoselective vaporization of the prostate with 120W HPS Greenlight laser is one of the most attractive modalities of surgical treatment for benign prostatic hyperplasia at present. The specific physical characteristics of this laser provides an excellent safety and effectiveness profile, making it the ideal technique for high-risk patients or patients ongoing oral anticoagulation. Moreover, the undeniable reduction of urethral catheterization time and hospital stay compared to transurethral resection of prostate (TURP) involves a much more comfortable postoperative period for patients. We have conducted a Medline/Pubmed search, presenting in this review the outcomes and current surgical techniques described in recent studies. We have also reviewed the controversial aspects and limitations attributed to this technique.

[Updated analysis of the efficacy of therapeutic options in primary vesicoureteral reflux]. / Análisis actualizado sobre la efectividad de las opciones terapéuticas del reflujo vesico-ureteral primario.

OBJECTIVES: The primary objective of this study is to perform a systematic review of the therapeutic management of primary VUR in pediatric urology. METHODS: A systematic review of the articles published in all of the available databases has been performed, including scientific evidence-based medicine criteria. Inclusion criteria concerning basic quality of the articles were considered essential, as well as exclusion criteria to be able to reject the articles. RESULTS: A critic reading of selected articles, and statistical study of grouped data was performed according to the type of treatment and benefits contributed by each treatment, and also to their undesirable effects. CONCLUSIONS: The following Conclusions were drawn from the results obtained and from the analysis of the texts. Both medical and surgical treatment present similar effectiveness concerning resolution of grades I, II and III VUR, and the former one is the recommended initial treatment following diagnosis. Endoscopic treatment is exactly as effective as open surgery for grades I, II and III with fewer undesirable secondary effects. There are no differences concerning the efficacy of the different injected substances. Not enough evidences exist for degrees IV and V that may recommend or advise against any of the treatments. In any degree of VUR, open surgical treatment is superior as far as medical treatment is concerned only regarding the number of acute pyelonephritis episodes during follow-up. This conclusion cannot be applied on endoscopic treatment.

Biopsia de masas renales: resultados y seguridad en 2009 / Renal mass biopsy: Results and safety in 2009

El papel de la biopsia de masas renales ha sido hasta ahora limitado por los resultados insatisfactorios en cuanto a fiabilidad diagnostica y por su escasa repercusión en las decisiones terapéuticas. Recientemente las BMR han recobrado interés entre los urólogos, debido al aumento de incidencia de tumores renales, la aparición de nuevas opciones de manejo y los avances en el diagnóstico histológico. Hemos revisado mediante una búsqueda en Pubmed, las publicaciones más relevantes sobre biopsias de tumores renales aparecidas en los últimos años. Los estudios clínicos más recientes demuestran un alto grado de fiabilidad diagnostica para diferenciar malignidad, tipo histológico y grado de las biopsias percutáneas de tumores renales, con una baja tasa de complicaciones asociadas. Sin embargo su utilización rutinaria continúa siendo controvertida y sus indicaciones limitadas dada la escasa capacidad de modificar la actitud terapéutica (AU)

The role of renal mass biopsies has been limited by suboptimal results in terms of diagnostic reliability, and their scant repercussion upon therapeutic decision taking. Recently, however, renal mass biopsies have generated renewed interest among urologists, as a result of the increased incidence of renal tumors, the introduction of new management options, and advances in histological diagnosis. A review has been made, based on a PubMed search of the most relevant publications on renal tumor biopsies in recent years. The most recent clinical studies reveal a high degree of diagnostic reliability in differentiating malignancy, histological type and grade in percutaneous biopsies of renal tumors, with a low rate of associated complications. However, routine use of the technique remains controversial, and its indications limited, due to the scant capacity of the renal biopsy findings to modify treatment decision (AU)

Papel actual de la fotovaporización prostática con Láser Greenlight HPS. Aspectos técnicos y revisión de la literatura / Photoselective vaporization of the prostate with Laser Greenlight HPS: current role, technical aspects and review of the literature

La fotovaporización prostática (FVP) con láser Greenlight HPS 120W es una de las modalidades para el tratamiento quirúrgico de la hiperplasia benigna de la próstata (HBP) más atractivas en la actualidad. Las características físicas propias de este láser le dotan de un excelente perfil de seguridad y eficacia, convirtiéndola en la técnica ideal para pacientes de alto riesgo quirúrgico o con anticoagulación/antiagregación activa. Además, la incuestionable disminución del tiempo de sondaje y de hospitalización con respecto a la resección transuretral de la próstata (RTUp), implica un postoperatorio inmediato mucho más cómodo para los pacientes. Hemos realizado una búsqueda bibliográfica en Medline/Pubmed, presentando en esta revisión los resultados de los estudios más recientes, así como las actuales técnicas quirúrgicas. También hemos revisado las limitaciones y aspectos controvertidos que se atribuyen a esta técnica en función de lo publicado en la literatura (AU)

Photoselective vaporization of the prostate with 120W HPS Greenlight laser is one of the most attractive modalities of surgical treatment for benign prostatic hyperplasia at present. The specific physical characteristics of this laser providesan excellent safety and effectiveness profile, making it the ideal technique for high-risk patients or patients ongoing oral anticoagulation. Moreover, the undeniable reduction of urethral catheterization time and hospital stay compared to transurethral resection of prostate (TURP) involves a much more comfortable postoperative period for patients. We have conducted a Medline/Pubmed search, presenting in this review the outcomes and current surgical techniques described in recent studies. We have also reviewed the controversial aspects and limitations attributed to this technique (AU)

Paciente con SDT y dislipemia / Patient with testosterone deficit syndrome and dyslipemia

Entendemos por dislipemia o dislipidemia, a la presencia anormalmente elevada de lípidos en sangre. Las principales son la hipercolesterolemia (colesterol por encima de los 240mg/dl), la hipertrigliceridemia (cifra de triglicéridos superior a 200mg/dl) y la hipoalfalipoproteinemia (lipoproteinas de alta densidad, llamadas también colesterol HDL, menor de 40mg/dl). La presencia de lípidos en exceso contribuye a la aterosclerosis y son un factor independiente de riesgo cardiovascular (1) (Tabla I). Pueden ser primarias si tienen un origen genético y no están asociadas a otras enfermedades, pero la mayoría de las veces son secundarias a otras entidades patológicas como diabetes, hipotiroidismo, obesidad y síndrome metabólico (SM). En nuestra sociedad actual el sedentarismo y las dietas inadecuadamente hipercalóricas están haciendo que la obesidad y el síndrome metabólico crezcan en prevalencia día a día, y que su relación con las dislipemias se haya hecho más estrecha (AU)

La obesidad se relaciona con todos los criterios de síndrome metabólico (SM). Pero obesidad no es ni mucho menos sinónimo de síndrome metabólico. Por una parte la distribución de grasa no es igual en todos los individuos ni confiere el mismo riesgo. En este sentido sabemos que la localización abdominal de la grasa, se relaciona con mayor intensidad con la resistencia a la insulina (RI) y el SM (AU)

We define dyslipemia as the abnormally elevated presence of lipids in the blood. The main ones are hypercholesterolemia (cholesterol over 240 mg/dl), hypertrigliceridemia (triglicerides level over 200 mg/dl) and hipo-alphalipoproteinemia (High density lipoproteins, also called HDL Cholesterol, below 40 mg/dl). The presence of excessive lipids contributes to arteriosclerosis and they are an independent cardiovascular risk factor (1) (Table I).It may be primary, if they have genetic origin and they are not associated with other diseases, but in most cases they are secondary to other pathological entities such as diabetes, hypothyroidism, obesity and metabolic syndrome (MS). In our current society, sedentary lifestyle and unadequatelly hypercaloric diets are making obesity and MS prevalences grow, and their relation to dyslipemias has become tighter. Obesity is related with all the criteria for MS. But obesity is not at all synonymous of MS. On the one hand neither fat distribution is the same in all individualas nor confers the same risk. Accordingly, we know that abdominal localization of fat is related to higher intensity of insulin resistance (IR) and MS. On the other hand, it seems that certain components of MS are determined by genetic factors, since there are morbid obese persons that are metabolically healthy and other patients develop insulin resistance without obesity. So that, it seems that the excess in visceral adiposity in the presence of certain genetic factors would be the most related cause of the appearance of peripheral insulin resistance and diabetes mellitus, hyperlipidemia (increase of very low density pipoproteins (VLDL)), decrease of highdensity lipoproteins (HDL), arterial hypertension, and hypogonadotropic hypogonadism, composing what we call metabolic syndrome. In this scenario, we urologists are being first-hand witnesses (AU)

Análisis actualizado sobre la efectividad de las opciones terapéuticas del reflujo vesico-ureteral primario / Updated analysis of the efficacy of therapeutic options in primary vesicoureteral reflux

Objetivo: El propósito principal de nuestro trabajo fue realizar una Revisión Sistemática (RS) sobre el manejo terapéutico del Reflujo Vésico Ureteral Primario (RVUP). Métodos: Para ello se ha realizado una RS de los artículos aparecidos en todas las bases de datos disponibles, aplicando unos criterios de inclusión y exclusión de calidad mínima imprescindible. Resultados: Se ha realizado lectura crítica de los artículos seleccionados y el estudio estadístico correspondiente de los datos agrupados, según el tipo de tratamiento y beneficios aportados, así como sus efectos indeseables. Conclusiones: El tratamiento médico y el quirúrgico presentan la misma efectividad en la resolución de los grados I, II y III de RVUP, recomendándose el primero de ellos como tratamiento inicial tras el diagnóstico. El manejo endoscópico es igual de efectivo que la cirugía abierta, con menores efectos secundarios, sin haber encontrado diferencias entre las distintas sustancias analizadas para la inyección. Para los reflujos de alto grado IV y V no existen evidencias suficientes que aconsejen o desaconsejen cualquiera de los tratamientos. El tratamiento quirúrgico abierto, para cualquier grado de RVU, sólo presenta superioridad con respecto al tratamiento médico en el número de episodios de pielonefritis aguda durante el seguimiento. Esta afirmación no es posible aplicarla para el tratamiento endoscópico (AU)

Objectives: The primary objective of this study is to perform a systematic review of the therapeutic management of primary VUR in pediatric urology. Methods: A systematic review of the articles published in all of the available databases has been performed, including scientific evidence-based medicine criteria. Inclusion criteria concerning basic quality of the articles were considered essential, as well as exclusion criteria to be able to reject the articles. Results: A critic reading of selected articles, and statistical study of grouped data was performed according to the type of treatment and benefits contributed by each treatment, and also to their undesirable effects. Conclusions: The following Conclusions were drawn from the results obtained and from the analysis of the texts. Both medical and surgical treatment present similar effectiveness concerning resolution of grades I, II and III VUR, and the former one is the recommended initial treatment following diagnosis. Endoscopic treatment is exactly as effective as open surgery for grades I, II and III with fewer undesirable secondary effects. There are no differences concerning the efficacy of the different injected substances. Not enough evidences exist for degrees IV and V that may recommend or advise against any of the treatments. In any degree of VUR, open surgical treatment is superior as far as medical treatment is concerned only regarding the number of acute pyelonephritis episodes during follow-up. This con-clusion cannot be applied on endoscopic treatment (AU)