[Assisted extraction using extracorporeal lithotripsy of the calcified ureteral catheter overlooked for 2 years]. / Extracción asistida mediante litotricia extracorpórea de un catéter ureteral calcificado olvidado 2 años.

A 45 year old man with a 2 year forgotten left double-pigtail ureteric stent was referred to our hospital. Because of distal calcifications, the stent could not be removed by means of a cystoscopy. So, extracorporeal wave lithotripsies were performed and then the stent were easily removed in two fragments by cystoscopy and ureteroscopy.

[Treatment of bladder lithiasis with shock-wave extracorporeal lithotripsy]. / Tratamiento de la litiasis vesical mediante litotricia extracorpórea por ondas de choque.

PURPOSE: To evaluate the effectiveness and the prognostic factors of the bladder stones (BS) treatment by means of extracorporeal shock wave lythotripsy (ESWL). METHODS: 183 patients with BS treated using ESWL were retrospectively analysed. Independent variables were: gender, age, obstruction, BS size, BS number and amount of waves. Dependent variable was total BS resolution. Statistical analysis was provided by Cox's regression multivariate analysis, Kaplan-Meier analysis and the t Student test. RESULTS: Total effectiveness of the treatment was 73%. Initial BS size was the only prognostic factor on multivariate analysis (p = 0.0035) with smaller stones obtaining the best results (log rank p = 0.00001): 92% of effectiveness in BS smaller than 1 cm2, 73% in 1-2 cm2, 57% in 2-3 cm2 and 42% in larger than 3 cm2. BS mean size decreased 2 cm2 after the first ESWL (p = 0.00001). CONCLUSIONS: Initial BS size was the only prognostic factor of resolution. Total effectiveness was 73% and it highly increased in BS smaller than 2 cm2.

[Validation in Spain of the quality of life questionnaire PROSQOLI in patients with advanced prostate cancer]. / Validación en España del cuestionario de calidad de vida PROSQOLI en pacientes con cáncer de próstata avanzado.

OBJECTIVES: Validation of the PROSQOLI questionnaire adapted to Spanish, pursing an instrument to evaluate, in the common clinical practice, the quality of life in patients with locally advanced or disseminated prostate cancer in our country. MATERIAL AND METHODS: A cross-sectional prospective study was designed in 750 patients (150 centers) with disseminated or locally advanced prostate cancer (TNM criterion) who came to the scheduled check-up. Socio-demographic and clinical data of the participants were collected. The subjects filled out the PROSQOLI and EQ-5D questionnaires. The analysis included 561 cases that met the selection criteria. The psychometric characteristics (feasibility, validity and reliability) of the adapted PROSQOLI questionnaire were studied. RESULTS: Mean age was 73.63 (7.59) years. A total of 72.01% of the participants had locally advanced disease. In 28.16%, the primary treatment was radiotherapy, in 12.30% it was prostatectomy. A total of 83.48% received hormone treatment. The mean for each scale of the PROSQOLI questionnaire varied from 68.86 to 74.51. The percentage of no response was less than 3% for each scale. The percentage of subjects with minimum score in any scale was negligible, and the maximum score did not surpass 5%. Mean time to fill out the questionnaire was 109.42 (101.00) seconds. Cronbach's α coefficient was 0.937 and the total item correlation was superior to 0.7 for all the items. Correlations with the EQ-5D questionnaire were moderate. Scores on the questionnaire were associated to all the parameters studied related to the disease. CONCLUSIONS: The adapted questionnaire has adequate psychometric properties for its use in research and in the clinical practice.

[Ureteral stenosis and pneumatic dilatation]. / Estenosis ureteral y dilatacion neumática.

OBJECTIVE: To determine the efficacy of balloon dilatation in the treatment of ureteral strictures and analyze the outcome according to its etiology. METHODS: 77 ureteral dilatations were performed in 74 patients. Most of the strictures were postoperative sequelae and the other cases were due to chronic inflammatory conditions. RESULTS: The overall success rate was 47%, partial improvement was achieved in 17% and the failure rate was 36%. In our series, the postoperative strictures responded slightly better to balloon dilatation than those arising from chronic inflammatory conditions. CONCLUSION: Endourologic techniques based on the percutaneous methods of interventional radiology have reduced the usage of invasive conventional surgery in the treatment of strictures. Although the proportion of unsatisfactory results is not negligible, balloon dilatation should be the first treatment option for ureteral strictures because it is less invasive, carries a low morbidity and requires a shorter hospitalization. If the results are unsatisfactory, re-dilatation can be attempted or conventional open surgery can be performed.

A double-blind randomized placebo trial on very high doses of acyclovir in weakly symptomatic HIV-patients.

Herpesvirus infections are thought to be cofactors of the human immunodeficiency virus (HIV) disease, and high concentrations of acyclovir (ACV) are active on all herpesviruses. Because ACV was shown to delay the cytopathic effect of HIV in vitro, we evaluated the effect of intermittent high doses of ACV in mildly symptomatic HIV-patients in a randomized double-blind placebo-controlled trial with a 4-month treatment period. A total of 30 CDC II and III patients were enrolled; 24 (80%) completed the study. Placebo and ACV were given once a week in a 3-h infusion with 1 g oral probenecid. Each dose of ACV was 50 mg/kg. Pharmacokinetic data were obtained from patients of the preliminary open study. The obtained concentrations were effective against both herpesviruses and HIV: peak concentrations were 197 and 11 mumol/l in serum and CSF, respectively; the CSF:serum ratio of the areas under the curve was 82%. Two patients with placebo acquired hairy leukoplakia and detectable antigenemia vs. none in the ACV group (p = 0.23). T-helper cell count over the 4-month period decreased in the placebo group while it increased in the ACV-treated group (mean of change = -105 c/microliters vs. +68 c/microliters; p = 0.06). beta 2-microglobulin increased with placebo and did not with ACV (mean of change = +0.63 mg/l vs. -0.27 mg/l, p less than 0.025). Only one patient had, at one time, transient elevation of creatinemia related to ACV. We concluded that weekly high doses of ACV were able to delay the progression of some significant markers of HIV disease. Thus, preventive/prophylactic treatment of herpesvirus infections could be useful in mildly symptomatic HIV patients. Further larger trials using a more feasible treatment are warranted.

[Assessment of erectile dysfunction with Doppler-duplex ultrasonography]. / Valoración de la disfunción eréctil mediante ecografía Doppler-duplex.

OBJECTIVE: To evaluate the penile echo Doppler study and review the anatomy, perfusion, innervation and physiology of erection. METHODS: The technique, spectral morphological changes of the cavernous arteries after drug-induced erection, modifications and normal values are described. RESULTS/CONCLUSION: Impotence or erectile dysfunction, which is defined as the inability of the male to achieve or sustain an erection sufficient for successful sexual intercourse, is a benign condition with an important impact on the wellbeing of the patient. Statistical studies have shown a high age-dependent prevalence in healthy subjects and an association with different conditions in patients. To establish whether impotence is organic or not and to identify its underlying cause require submitting the patient to not a few diagnostic tests. Since most of the cases of organic impotence are of vascular origin, it is necessary to utilize a diagnostic method that can identify patients with an underlying vascular disorder (the most common cause) and distinguish those with arteriogenic impotence from those with insufficiency of the complex corporeal veno-occlusive system.

[Analysis and clinical course of residual lithiasis after shock wave renal treatment]. / Análisis y evolución de la litiasis residual tras la aplicación renal de ondas de choque.

OBJECTIVE: Although residual lithiasis after the application of shock waves is a situation that coexists with the procedure, in some cases it can be considered to be a failure of ESWL. The natural history and outcome of 244 cases of residual renal stone followed over a 5-year period are analyzed, and the approach based on a pre-established classification is discussed. METHODS: Of 1,407 patients treated by ESWL for renal lithiasis during 1995, 244 cases with a renal calculus larger than 3 mm were followed for a period of 5 years after treatment and evaluated by clinical, radiological, ultrasound and analytical methods. RESULTS: At 3 months post-ESWL, 1,013 cases (72%) were completely stone-free and 394 (28%) showed residual stone; of these, 244 (62%) had residual stone fragments greater than 3 mm. At 5 years, 190 (78%) remained stable and the remaining 54 (22%) showed stone regrowth that warranted additional treatments: 52 ESWL, 1 PNL and 1 partial nephrectomy. Despite the retreatments, only 42% became completely stone-free. CONCLUSIONS: A classification of residual renal stone can be established based on the data obtained to orient the approach in each case, although the frequency of residual stone can be reduced by the appropriate indication of ESWL. Once a renal stone has formed retreatments with ESWL cannot ensure complete elimination of the stone.

Extracción asistida mediante litotricia extracorpórea de un catéter ureteral calcificado olvidado 2 años / Extracorporeal wave lithotripsy assisted drawing of a calcified ureteral stent left out for two years

Se presenta el caso de un varón de 45 años que llevaba olvidado durante 2 años un catéter ureteral doble J izquierdo. El catéter presentaba ambos extremos calcificados no pudiéndose extraer mediante cistoscopia y pinzas. Se realizaron sesiones de litotricia extracorpórea en ambos extremos consiguiéndose la fragmentación de la litiasis y posteriormente pudo ser extraído en dos trozos mediante cistoscopia y ureteroscopia (AU)

A 45 year old man with a 2 year forgotten left double-pigtail ureteric stent was referred to our hospital. Because of distal calcifications, the stent could not be removed by means of a cystoscopy. So, extracorporeal wave lithotripsies were performed and then the stent were easily removed in two fragments by cystoscopy and ureteroscopy (AU)

Síndrome de Wünderlich. Hemorragia renal espontánea / Wünderlich syndrome. Spontaneous renal hemorrhage

La hemorragia renal espontánea o síndrome de Wünderlich es una afección de presentación rara pero, dada la situación urgente y en ocasiones vital que plantea, es de gran importancia. La etiología más frecuente es la causa tumoral. El diagnóstico se realiza principalmente por técnicas de imagen. Presentamos dos casos clínicos de este síndrome de origen tumoral y analizamos su diagnóstico y tratamiento (AU)

Tratamiento de la litiasis vesical mediante litotricia extracorpórea por ondas de choque / Bladder stone treatment with extracorporeal shock wave lithotripsy

FUNDAMENTO: Valorar la eficacia y los factores pronósticos de éxito del tratamiento de la litiasis vesical (LV), mediante litotricia extracorpórea por ondas de choque (LEOC). MÉTODOS: Estudio retrospectivo de 183 pacientes afectos de LV tratados mediante LEOC. Las variables independientes estudiadas fueron sexo, edad, obstrucción, tamaño de la LV, número de LV y número de ondas. La variable dependiente fue la desaparición total de la LV. Estudio de los factores pronósticos mediante análisis multivariante por regresión de Cox, y análisis de Kaplan-Meier. Variación del tamaño de la LV estudiada mediante la prueba t de Student. RESULTADOS: Eficacia global del 73 por ciento. El análisis multivariante mostró que el único factor pronóstico fue el tamaño inicial de la litiasis (p = 0,0035). A menor tamaño de la LV mejor resultado (log rank p = 0,00001): eficacia del 92 por ciento en las LV menores de 1 cm 2 , 73 por ciento entre 1-2 cm 2 , 57 por ciento de 2-3 cm 2 y 42 por ciento en mayores de 3 cm 2 . Disminución media del tamaño de la LV tras la primera sesión de LEOC de 2 cm 2 (p = 0,0001). CONCLUSIONES: El único factor pronóstico fue el tamaño inicial de la LV. La eficacia global de la técnica es del 73 por ciento, aumentando considerablemente en LV menores a 2 cm 2 (AU)