[Urethral diverticulum. Our casuistic and the literatura review]. / Divertículos uretrales. Revisión de nuestra casuística y de la literatura.

PURPOSE: The possible etiopathogenic factors, symptoms, diagnostic methods, surgical management and complications of the urethral diverticula are reviewed. MATERIALS AND METHODS: A retrospective study of the clinical charts with urethral diverticula diagnosis during the period 1986-2006 was carried out. RESULTS: In the last 20 years a total of 19 patients have been treated for this pathology: 15 females and 4 males. Five of the females started with a sensation of vaginal mass; the rest were diagnosed of micturitional (irritative) syndrome, urinary incontinence or urinary infection. In the case of males, 3 of them had a palpable tumour in the penis. The most used diagnostic method was retrograde and voiding cystourethrography; urethrography with double-occlusion balloon catheter was used in 5 cases and urethroscopy in 4 patients; other techniques of image diagnosis like magnetic resonance imaging were necessary for the most complex cases. The treatment was the excision of the diverticulum, except for one of the females who rejected the treatment. The evolution in all treated women was successful, according to follow up 2 years after the treatment. In males, two of them had complex recurrent diverticula. CONCLUSIONS: Urethral diverticula are nosologic entities of difficult diagnosis, due to their low prevalence and their unspecific clinic, therefore diagnosis is sometimes incidental. The etiopathogenity is acquired in most cases and its surgical treatment is more challenging in males than in females probably linked to the fact that diverticula appear in urethras with previous surgery, endourologic manipulation or associated injuries.

[Cystadenoma of seminal vesicles]. / Cistadenoma de vesículas seminales.

Cystadenoma of the seminal vesicles is a extremely rare pathology. To our knowledge only eight cases have been reported in the literature. We report a new case of this benign tumor, bilaterally located and incidentally found at surgery. Literature is reviewed and clinical, diagnostic and therapeutic aspects of these are discussed.

[Renal transplantation in patients with enterocystoplasty]. / Trasplante renal en pacientes con enterocistoplastia.

OBJECTIVES: To asses the impact of augmentation enterocystoplasty on the success of cadaveric renal transplantation in patients with dysfunctional bladders. PATIENTS AND METHODS: Between 1980 and 2001, 3 men and a woman with severe dysfunctional lower urinary tract underwent a total of 4 cadaveric renal transplantations. The etiologies of the bladder dysfunction were bladder contraction secondary to urinary tuberculosis in all cases. In 3 patients were performed an enterocystoplasty with ileocecal segment and one with ileon. RESULTS: The overall allograft survival was 58.7 months. Two patients have functioning grafts 27 and 74 months after transplant, 1 has died due to an intestinal disease and other had chronic rejection after follow-up of 98 months. Technical complications occurred in 3 patients. All patients remain continent without catheterization after the transplantation. CONCLUSIONS: Enterocystoplasty is a safe and effective method of restoring lower urinary tract function in the patient with end stage renal disease and a small non compliant bladder.

[Vesicouterine fistula. Our experience of 25 years]. / Fístulas vesicouterinas. Nuestra experiencia tras 25 años.

OBJECTIVE: To determine the current state of vesicouterine fistulae in our hospital, the factors associated with their development and the findings obtained from the treatments used. MATERIAL AND METHODS: We carry out a retrospective study on a group of patients suffering from vesicouterine fistulae who were treated in our service for the last 25 years with a 2 year minimum follow-up. RESULTS: 6 cases of vesicouterine fistulae were evaluated. In 83.3% (5/6) of the cases occurred following caesarean section. The average age of the patients was 36.5 years old. In 50% of the cases, urinary incontinence immediately after surgery determined an early diagnosis. In 5 patients deferred abdominal surgical approach was carried out. All of the patients remained asymptomatic during the follow-up years. Two pregnancies were recorded 24 months after repair with a full term delivery. CONCLUSIONS: The vesicouterine fistula, despite being infrequent, is no longer an exceptional diagnosis. Currently, the low segmentarian caesareans constitute the major isolated risk factor for fistula development. We recommend a deferred surgical repair without discarding a conservative approach for those cases of small and early fistula.

[Surgical wound infection in renal transplant recipients]. / Infección de herida operatoria en trasplantados renales.

Between 1980 and 1991, 504 transplantations were performed in our hospital. All patients received pre-surgical therapy with antibiotics. The total incidence of surgical wound infection was 15 cases (3%). After reviewing all parameters that could have been involved in the development of these infections, it become apparent that diabetes mellitus, more than one transplant in the same patient, development of haematoma in the wound and presence of urinary fistulae were statistically significant (p < 0.05). On the other hand, the use of the different immunosuppressive regimes (azathioprin and cyclosporin) and acute tubular necrosis showed no statistical significance (p > 0.05); also, no relationship was found between infection and acute graft rejection.

Spontaneous healing of ureterogenital fistulas: selection criteria.

We present 12 cases with spontaneous healing of ureterovaginal (11 cases) and ureterouterine (1 case) fistulas. In every case disappearance of the fistula with normal renal function and restoration of the excretory tract was obtained. IVP and retrograde pyelographs were performed in every case. Spontaneous healing is feasible under the following conditions: continuity of the ureteral lumen and normality of the infralesional ureter. Spontaneous healing is independent of the number of affected ureters, age, gynecological pathology, gynecological intervention, latency period, urographical findings, duration of incontinence, and urinary infection.

[Ureteral complications following an aorto-femoral by-pass. Presentation of a case of ureteral lesion with urinary extravasation]. / Complicaciones ureterales consecutivas a by-pass aortofemoral. Presentación de un caso de lesión ureteral con extravasación urinaria.

A case of ureteral injury with urinary extravasation following aortofemoral by-pass is presented, the world bibliography of ureteral complications following aortofemoral by-pass reviewed. As possible causes of the ureteral injury of our case, a) decubitus by the dacron prosthesis and b) retroperitoneal fibrosis, are stressed. The etiology and the different methods of treatment are discussed.

Spontaneous healing of uretero-vesico-vaginal fistulas.

We report a rare case of spontaneous healing of a left uretero- and vesicovaginal fistula observed simultaneously in a patient. We have not found reports of similar cases in the reviewed literature. We also suggest the pathogenic mechanisms responsible for total healing.

[Torsion of the hydatid of Morgagni]. / Torsión de las hidatides de Morgagni.

The authors present 6 cases of torsion of Morgagni's hydatid treated in the Emergency Urology Department over a two-year period. They stress the importance of the clinical diagnosis, as well as the differential diagnosis with other "acute, testicular bag" processes, in particular with funicular torsion. Surgical treatment is the only way of overcoming the pain, confirming the diagnosis and preventing the risk of secondary, testicular atrophy.

[Injuries of the ureter caused by gynecologic surgery. Experience in the treatment of 42 cases]. / Lesiones traumáticas del ureter condicionadas por la cirugía ginecológica. Nuestra experiencia en el tratamiento de 42 casos.

These operations, in which the risk is essentially ureteral, must be carried out in a urological rather than gynaecological way; the said ureter must be sought after a permanent, ureteral probe has been placed before the operation. We feel that a vaginography is more useful than a retrograde pyelography for diagnosing ureterovaginal fistulae. Another important indication is the need for an intravenous urography to be systematically carried out in the postoperative period of all pelvis operations. Only I.V.U. enables the discovery in time of ureteral lesions which would otherwise remain undiscovered too long. We feel that nephrostomy is an emergency therapy in cases of anuria and septic shock with a urinary focus. It is a safety measure for preventing kidney deterioration in ureter lesions which have remained undiscovered for a long time. In pelvic ureter lesions and providing that there is no vesical retraction, we perform a vesical psoization along with the ureterocystoneostomy (1). When the ureteral lesion is bilateral and the elasticity of the bladder enables us to do so, we perform a ureterocystoneostomy with vesical bipartition and psoization of both vesical wings. In cases of extensive, bilateral ureteral lesions associated with vesical damage such as: vesico-vaginal fistulae and retracted bladder, we perform a ureteroileocystoplasty and vesical stretching.

Signet ring cell adenocarcinoma of the urachus.

Signet ring cell adenocarcinoma of the bladder is rare. Only 16 cases are recorded in the literature, although two meet the requirements for being considered of urachal origin. We present the third case of signet cell adenocarcinoma of urachal origin.

[Metastatic tumors of the penis]. / Tumores metastásicos de pene.

The authors present four cases of metastasic penis tumours, two of which followed a prostate carcinoma, one vesical carcinoma and the other a carcinoma of the excretory duct. They make a review of world literature on the subject and study the possible ways of dissemination as well as the clinical picture and differential diagnosis with other pathological processes of the male genital organ and they stress in particular the bad prognosis as the metastases appear at a very advanced stage of the primitive illness.

[Use of the great epiploon in the treatment of idiopathic retroperitoneal fibrosis]. / Empleo del epiplón mayor en el tratamiento de la fibrosis retroperitoneal idiopática.

Immediately after ureterolysis in the treatment of idiopathic retroperitoneal fibrosis, we covered the ureter with a large epiploon, forming a sheath with omentum covering the entire ureter from the renal pelvis to the juxtavesical area of the same. This technique revitalizes the ischemic ureter resulting from ureterolysis and protects against the reinclusion of the ureter mobilized inside the sclerolipomatous mass.

[Treatment of inflammation processes of the lower urinary tract with dimethyl sulfoxide]. / Tratamiento de los procesos inflamatorios del tracto urinario inferior con dimetil sulfoxido.

We present 8 patients treated with Dimethyl-sulphoxide, suffering from inflammatory processes of the lower, urinary tract which include: interstitial cystitis, urethral syndrome, incrustation of the prostatic cell, actinic cystitis and chronic prostatitis. All the patients have shown an improvement in their symptoms which, along with the absence of side effects and its easy administration, means that the said drug constitutes a means of therapy to be taken into account in the treatment of these inflammatory processes, following the consideration of more aggressive therapies.

[Renal liposarcoma: diagnostic and therapeutic considerations]. / Liposarcoma renal: consideraciones diagnósticas y terapéuticas.

We report on two cases of renal liposarcoma. The clinical features of this tumor type are described and diagnostic and therapeutic considerations are put forward. The usefulness of CT in the diagnosis of this disease entity is underscored. This permits us to evaluate the response to treatment and furthermore, it permits early detection of recurrence.

[Duplex ultrasound before and after intracavernous papaverine injection in the diagnosis of impotence]. / El eco dúplex pre y post-inyección intracavernosa de papaverina en el diagnóstico de la impotencia.

The study of impotentia coeundi requires separating the organic from the psychogenic cause. Arteriogenic impotence falls within the first group and has been assessed with the papaverine test, simple Doppler and arteriography. Currently, more sophisticated techniques such as the pulsed Doppler permit noninvasive assessment of the blood supply to the penile arteries. Intracavernous injection of vasoactive substances such as papaverine cause vascular changes. Evaluation of these changes permits making the diagnosis of arterial insufficiency without recurring to more invasive diagnostic techniques such as arteriography. Currently, this invasive technique is only justified in revascularization surgery but not for diagnosis. The availability of color Doppler facilitates arterial evaluation even further.