[Treatment of the dysfunction of the pelvic floor]. / Tratamiento de la disfunción del suelo pélvico.

The perineum is formed by muscle-aponeurotic elements that are integrated under the control of the nervous system. Their alterations are responsible for urogynecological, coloproctologic and sexual pathologies. In order to obtain a successful treatment, it is obliged not to forget the role that plays the perineum in those pathologies. The treatment of the dysfunction of the pelvic floor groups conservative techniques and procedures like changes in life habits, behavioural therapy, biofeedback, electroestimulation (neuromodulation and peripheral electrical stimulation) and training with muscular exercises of the pelvic floor (perineal rehabilitation). The objective of all of them is to improve or to obtain the urinary continence, the strengthening of its musculature to be able to balance pelvic static, to improve the local vascularization and the anorrectal function besides securing a satisfactory sexuality.

[Cystic ureteritis in a kidney transplantation candidate]. / Ureteritis quística en paciente candidata a trasplante renal.

Cystic ureteritis is a very uncommon pathology, whose pathogenesis is not well established. It is usually asociated with chronic infectious factors. It presents unspecific symptoms but characteristic radiologic findings. There is not an especific treatment for this disease. Kidney transplant is the final pathway for patients with chronic renal failure. We report a case of cystic ureteritis diagnosed during pre-transplant study.

[Biofeedback as a therapeutic alternative in uncoordinated miction]. / El biofeedback como alternativa terapéutica en la micción no coordinada.

The Hinman Syndrome is known as an involuntary unsconscions contraction of the periurethral sphincter during micturition once neurologic disease and anatpmical obstruction are rejected. We report a case of a 23 years old man who was diagnosed of suffering from this syndrome. After the proper studies and left nephroureterectomy for ureterohydronephrosis secondary to long term massive vesicoureteral reflux, we proceeded to treat him with biofeedback and autocatheterisms. Six months after, the patient was asymptomatic with normal micturitions without residue.

[Urodynamics in kidney transplantation]. / La urodinámica en el transplante renal.

OBJECTIVES: The importance of establishing a protocol for the urological evaluation of patients awaiting renal transplantation is due to the fact that 30% of these adult patients and up to 70% of these children develop renal failure due to a urological condition. The present study analyzes the importance of urodynamic evaluation in these patients. METHODS: 650 patients awaiting renal transplantation were evaluated by patient history, physical examination, US, Cystouretyhrography, and flowmetry. Thereafter 201 patients with the following conditions were selected for urodynamic assessment: vesicoureteral reflux, changes in bladder morphology (diverticulum, trabeculation), inadequate infundibulization of the bladder neck, diabetes, neurogenic bladder, obstructive pathology and bladders with a small volume capacity. The urodynamic study consisted of instantaneous voiding, cystomanometry and urethral pressure profile. RESULTS: Of these 201 patients, 45 had vesical hyperreflexia, 45 bladder disuse, 95 had a normal bladder, 12 had a hypoactive bladder and 2 had detrusor instability. CONCLUSION: The urodynamic study, apart from flowmetry, is basically indicated in patients awaiting renal transplantation who have a neurogenic bladder and/or suspected as having lower urinary tract obstruction.

[Unstable detrusor: usefulness of biofeedback]. / Detrusor inestable: utilidad del biofeedback.

Presentation of results of treatment using Biofeedback in two conditions which quite frequently associate vesical instability and incontinence: 65 cases of enuresis and 39 of urinary stress incontinence in females. The method was effective and achieved disappearance of detrusor instability in 78.2% of enuretic cases and 58.9% of urinary stress female incontinence. Outcome for incontinence was less favourable since disappearance was only achieved in 70.5% of enuretics and 20.5% cases of female incontinence. A brief description of the method and instrumentation used is done, which can be easily conveyed to any electromiographic device with real time output. The paper substantiates the authors' views relative to the likely pathogeny of the instability in both processes and the mechanism of action of Biofeedback techniques.

[Bladder carcinosarcoma. A clinical case]. / Carcinosarcoma vesical. Caso clínico.

Presentation of a new case of vesical carcinosarcoma in a 49 year-old male patient. The tumour's pathoanatomical study showed an epithelial pattern of transitional and squamous cells and a sarcomatous pattern composed of rabdomiosarcoma, osteochondrosarcoma and pleomorphous indifferentiated sarcoma with giant multinuclear cells. Histogenesis, signs and symptoms, and treatment, as well as the need of performing an immunohistochemical study for its diagnosis are discussed.

[Giant müllerian cyst. An infrequent cause of palpable hypogastric mass]. / Quiste mülleriano gigante. Una causa infrecuente de masa hipogástrica palpable.

Due to its remarkable rarity, large volume and good post-operative evolution, the authors present one case of a cyst from Müller's duct debris, 18 x 16 cm in size, in a 22-year old male who presented with tangible mass in the hypogastrium and occasional nycturia. The size conditions the clinical symptomatology, although the are times such as this, when they can acquire a considerable volume and grow with practically no symptoms. Clinical history and diagnostic methodology are explained, pointing out the most relevant clinical criteria for proper differentiation from other entities, the complexity of differential diagnosis and the therapeutical procedure used.

[Echographic studies in renal transplant. Our experience]. / Los estudios ecográficos en el trasplante renal. Nuestra experiencia.

The present study briefly reports our experience in the evaluation of renal transplantation by conventional and pulsed Doppler ultrasound. We advocate the use of both imaging techniques in these patients because these are safe, reliable, easy-to-use, reproducible noninvasive imaging techniques that afford a high diagnostic yield.

[Extrarenal complications in kidney transplant. Our experience]. / Complicaciones extrarrenales en el trasplante renal. Nuestra experiencia.

Since renal transplantation was introduced in the treatment of chronic end-stage renal failure, we have observed that extrarenal complications have an important role in transplant morbidity and mortality in hospital where kidney transplantation is not an uncommon procedure. The present study reports on the statistical data relative to extrarenal complications in kidney transplantation observed at our hospital, highlighting infectious, GI, respiratory, and hematologic complications because of their incidence.