[Evaluation of new intraurethral occlusive depot (ORIS FEMININO) in the management of female stress urinary incontinence]. / Evaluación de un nuevo dispositivo oclusivo intrauretral (ORIS FEMENINO) en el manejo de la incontinencia urinaria de esfuerzo femenina.

OBJECTIVE: To determine the utility and safety of an intraurethral device (Oris Femenino) in the management of female stress urinary incontinence. METHODS: A prospective clinical study was conducted on 54 female patients, mean age 46.4 years, with stress urinary incontinence. The degree and severity of the incontinence was determined before and one month after treatment with the intraurethral device. The reasons for the dropouts were analyzed and the rehabilitative effects two months after treatment had been completed were evaluated in 22 patients. RESULTS: 83% of the patients who completed the study referred positive results. A significant improvement was demonstrated for the degree of incontinence as well as the number of absorbent pads used. Age and severity of incontinence inversely correlated with positive results. A correlation between the absence of a previous urethropexy and positive results was also found. The dropout rate was 44% (24 patients) and was chiefly due to symptomatic bacteriuria in 14 cases and the difficulty in fixation and degree of incontinence. A statistically significant reduction was found in the number of pads used in the group of patients evaluated two months after treatment had been completed. CONCLUSIONS: The intraurethral device analyzed in this study significantly reduced urinary incontinence. This method appears to be more effective in younger women who are not severely incontinent and have not previously undergone urethropexy. The intraurethral device appears to have some rehabilitative effect on the perineal muscle. Symptomatic bacteriuria was found to be the main disadvantage.

[Lymphoproliferative pathology of the genitourinary tract. Report of 6 cases and review of the literature]. / Patología linfoproliferativa del tracto genitourinario. Aportación de 6 casos y revisión de la literatura.

OBJECTIVES: Six cases of genitourinary lymphoma are described and the literature reviewed. METHODS/RESULTS: The cases had the following histopathological diagnosis: 1 small and large cell non-Hodgkin lymphoma (NHL) of the renal pelvis, 2 high grade centroblastic testicular NHL; 1 centroblastic-centroid bladder NHL, 1 lymphoplasmocytoid bladder NHL and 1 low grade NHL of the prostate. All but the prostatic lymphoma were primary. Treatment was by nephrectomy and chop polychemotherapy (PCT) for the renal pelvis NHL, orchiectomy for the 2 testicular NHLs (one case also received radiotherapy), chop PCT for the bladder NHLs and PCT for the prostatic NHL. Three patients have died: the patient with renal pelvis NHL, centroblastic-centroid bladder NHL and the patient with prostatic NHL. CONCLUSIONS: Although these tumors are rare, they should be suspected in patients with lymphoma, elderly men with a testicular mass, patients with a large bladder compressing/infiltrating mass and in the immunnodepressed patients. A preoperative histopathological diagnosis must be made before performing radical surgery.

[Continuing neurologic assessment in myelodysplasia]. / Evaluación neurourológica continuada en la mielodisplasia.

OBJECTIVES: Myelodysplasia produces a neurological lesion with unpredictable urodynamic sequelae. The present study describes our experience in 18 patients with myelodysplasia and vesicourethral dysfunction. METHODS: The study comprised 18 patients (11 males and 7 females) with myelodysplasia and vesicourethral dysfunction. Patient median age was 15.7 years (range 7 months-57 years) and the mean follow-up was 20 months (range 7-47 months). After physical and neurological examination, all patients underwent a complete urodynamic evaluation, including selective electromyography of the periurethral sphincter and videocystography. The urodynamic studies were repeated regularly during follow-up. RESULTS: 14 patients (67.7%) showed a lower motor neuron vesicourethral dysfunction; 2 (11.1%) had upper motor neuron lesion and 2 (11.1%) mixed motor neuron lesion. During the study period, no alterations were observed in the urodynamic pattern of patients with upper or mixed motor neuron lesions, but 9 patients (64.2%) with lower motor neuron lesions showed changes in the urodynamic pattern compared with the first evaluation, with alterations in bladder compliance being the most frequent. CONCLUSIONS: Alterations in bladder compliance may arise from neurogenic and nonneurogenic factors. Our findings indicate the need for close urodynamic surveillance of patients with myelodysplasia and vesicourethral dysfunction.

[Urothelial tumors of the upper urinary tract: epidemiologic study, diagnostic assessment, and treatment]. / Tumores uroteliales del tracto urinario superior: estudio epidemiológico, evaluación diagnóstica y terapéutica.

OBJECTIVES: The result of an epidemiological study and evaluation of diagnosis and treatment of transitional cell tumors of the upper urinary tract are presented. MATERIAL AND METHODS: A retrospective study was conducted on 34 patients with transitional cell tumor of the upper urinary tract. RESULTS: The most common symptom was intermittent hematuria. Smoking was found to be the most important risk factor and 41.7% of the cases previously had a bladder cancer. IVP was the diagnostic technique most commonly utilized (61.7%). Nephroureterectomy was performed in 58.8% of the cases. Six cases had recurrence of the upper urinary tract tumor. There were 9 deaths (26.5%). CONCLUSIONS: The epidemiological data are similar to those of larger series. The tumors appear to develop in the presence of generalized urothelial disease. The low incidence of recurrence in the ipsilateral ureteral meatus indicates that resection of the distal ureter may not be required in patients at high risk.

[Vesicourethral dysfunction in the acquired immunodeficiency syndrome (AIDS)]. / Disfunción vesicouretral en el síndrome de inmunodeficiencia adquirida (SIDA).

OBJECTIVES: Ten patients with AIDS and voiding disorders were assessed to determine the most common type of lower urinary tract dysfunction and its possible usefulness in detecting neurological disease. METHODS: A complete urodynamic evaluation was performed. RESULTS: The most common symptom was urge incontinence and the most common urodynamic finding was detrusor-external sphincter dyssynergia. Of the 5 patients found to have a neurological disorder, only 3 had demonstrable functional disorder of the lower urinary tract (2 patients had detrusor hyperreflexia: one of them had a history of encephalopathy from HIV and the other patient had polyneuritis; the third patient had myelitis and a urodynamically diagnosed sympathetic decentration. CONCLUSIONS: Knowing the functional disorders of patients with AIDS can avoid complications and improve patient quality of life. Furthermore, it can be useful in detecting an existing neurological lesion or one that may develop in the future.

[Leiomyosarcoma within a bladder diverticulum]. / Leiomiosarcoma en el seno de un divertículo vesical.

Sarcomas are a rare entity among malignant tumours of the bladder. This paper presents the case of a male patient with leiomyosarcoma within a vesical diverticulum. The approach undertaken was diverticulectomy and, since the tumour was limited to the diverticulum and no metastatic disease was present, no other adjuvant therapy was considered.

[Renal metastasis from breast carcinoma: a new case and review of the literature]. / Metástasis renal de un carcinoma de mama: un nuevo caso y revisión de la literatura.

OBJECTIVES: Breast carcinoma is the most common malignant tumor in the female. A vast majority of the cases present metastasis at the time of diagnosis. A case of breast carcinoma metastatic to the kidney is described to emphasize that in the presence of a renal mass, a secondary or metastatic tumor should be suspected. The literature is briefly reviewed. METHODS: We report on the diagnosis and treatment of an expanding left renal mass in a female patient with a previous history of multiorgan tumors (ovarian, breast and small bowel) or different histological types that had been diagnosed and treated at different periods. RESULTS: Following radical nephrectomy, analysis of the surgical specimen disclosed a metastatic tumor from breast carcinoma. No subsequent treatment was required and the patient is well 6 months postoperatively. CONCLUSIONS: Metastasis from a primary tumor must be suspected in patients with a previous history of tumor presenting with a renal mass. Renal metastasis presents in the advanced stages of tumor dissemination. Treatment depends on patient general condition and the stage of the primary and metastatic tumors.

[Obstructive uropathy as a complication of aortic disease and reconstructive peripheral vascular surgery: report of 4 cases and review of the literature]. / Uropatía obstructiva como complicación de la patología aórtica y de la cirugía reconstructiva vascular periférica: presentación de 4 casos y revisión de la literatura.

OBJECTIVES: Ureteral injury can be a complication of peripheral vascular reconstructive surgery or aneurysm of the abdominal aorta. The present study analyses 4 cases of obstructive uropathy; 3 following peripheral vascular reconstructive surgery and 1 from aneurysm of the abdominal aorta. METHODS: All 4 patients were prospectively evaluated. RESULTS: Both renal units were compromised in all 4 cases. The initial management consisted of internal urinary diversion with a double J catheter. Ureterolysis was performed in one case of unresolved uropathy secondary to prior bypass surgery. One case with uropathy due to infection of the vascular prosthetic graft required graft replacement. CONCLUSIONS: The risk of ureteral injury is likely to be seen more often due to the increasing number of operations on the vascular tree and enhanced survival of patients with aortic aneurysm. Prevention of the foregoing complication includes doing US and/or IVP early postoperatively and in the first 4 months following surgery. Patient management is initially conservative.

[Urinary incontinence and bacteriuria in women]. / Incontinencia urinaria y bacteriuria en la mujer.

We analyzed the urodynamic data and their relationship with significant bacteriuria in 103 consecutive female patients (mean age = 55.7 yrs) with urinary incontinence. Significant bacteriuria was observed in 25.2% of the cases. E. coli was the pathogen most frequently isolated (70.3%). Significant bacteriuria was demonstrated in 29.3% of the patients with urge-incontinence. The most frequent type of incontinence in patients with bacteriuria was no urodynamic reproduction of urinary incontinence (42.8%). Bladder instability was not associated with significant bacteriuria (27.2%). Significant bacteriuria was observed in 75% of the patients with lower urinary tract obstruction, 66.6% of the patients who voided by abdominal straining and 26.3% of those with postvoiding residual urine. These findings indicate that urine culture should be done in patients with no urodynamic reproduction of urinary incontinence. There was no statistically significant correlation between urge-incontinence/bladder instability and significant bacteriuria. Consequently, antibiotics should not be used routinely in female urinary incontinence.

[Role of growth factors in the etiopathogenesis of benign prostatic hyperplasia]. / Implicaciones de los factores de crecimiento en la etiopatogenia de la hiperplasia prostática benigna.

A comment is made on the role growth factors play on the regulation of prostate growth. These factors require the mediation of an specific membrane receptor to which they have to bind in order to exercise their action correctly. The objective of the present job is to carry out a comprehensive review of each and every growth factor involved in prostate growth: family of the epidermal growth factor, family of the beta-transforming growth factor, and family of the fibroblast growth factor. As a final conclusion, it should be mentioned that the two prostate growth-regulating factors more extensively studied and with greater etiopathogenic relevance in benign prostate hyperplasia, are the epidermal growth factor and, more particularly, the fibroblast growth factor.

[Renal carcinoma with tumor embolism of the supradiaphragmatic inferior vena cava: therapeutic alternatives and review of the literature]. / Carcinoma renal con trombo tumoral en vena cava inferior supradiafragmática: opciones terapéuticas y revisión de la literatura.

We report a case of a man with a left renal cancer and vena caval thrombus extending to the right atrium, that was not possible to remove because infiltration of the posterior plane was detected intraoperatively. The patient was rehospitalized for intractable haematuria. He underwent selective embolization of the left renal artery with ethanol and coil. There were no complications and the patient is well seven months after the procedure. We review the literature on the diagnostic and therapeutic options in such cases. We can conclude that it is necessary to know the exact stage of the primary cancer in order to choose the best treatment. MRI or dynamic CT should be utilized to determine the presence of infiltration of adjacent structures or distant metastasis. Radical nephrectomy and the removal of the caval thrombus afford the only possibility of survival in these patients.

[Bladder amyloidosis in a female patient with suspected bladder carcinoma]. / Amiloidosis vesical en una paciente con sospecha de carcinoma vesical.

We report on a patient with a long history of rheumatoid arthritis who consulted for intense hematuria that was initially ascribed to carcinoma of the bladder. Subsequent patient evaluation, however, disclosed amyloidosis of the urinary bladder. The literature on amyloidosis of the urinary tract is reviewed. A detailed analysis of the biopsy specimens taken from a lesion that looks like a bladder carcinoma may disclose other pathologies such as amyloidosis of the urinary bladder.

[Retrovesical hydatid cyst]. / Quiste hidatídico retrovesical.

Hydatid disease is not an uncommon entity in endemic areas. However, the finding of an isolated cyst in the retrovesical region is less frequent. One such case is described herein. The diagnosis and therapeutic aspects are discussed.

[Distal urethral obstruction in girls: a diagnosis to keep in mind]. / Obstrucción de la uretra distal en niñas: un diagnóstico a tener en cuenta.

Although obstruction of the distal urethra is uncommon in the female, it should not be discarded if the patient is a young girl who consults for symptoms as diverse as enuresis, frequency and urgency, urinary infections, etc. Such a case is reported herein. The patient underwent internal urethrotomy which resolved the obstruction and eliminated the symptoms.

[Renal injury on a pathological kidney. Incidence, management, and results of treatment]. / Traumatismo renal sobre riñón patológico. Incidencia, manejo y resultados de tratamiento.

The present study reports our experience in the management of 13 patients with trauma to previously asymptomatic pathological kidney (11.6% of 112 cases of renal trauma treated over the period 1980-1990). The diagnostic difficulties and treatments, which are unlike those of trauma to normal kidney, are discussed and the literature reviewed. Hydronephrosis from ureteropelvic junction stenosis was the preexisting pathology that was frequently diagnosed (41.6%), followed by trauma to kidney with tumor (30.7%). Twelve (92%) patients underwent surgery: 2 (15.3%) were emergency and the rest were elective surgery. One patient with hilar sinus cysts received medical treatment. Conservative surgery was performed in 5 renal units (1 with bilateral involvement) and nephrectomy was performed in 8 patients (65.1%). The kidney with a tumor is more compromised by the renal injury. Furthermore, post trauma contusion/laceration of the tumor may present problems relative to tumor stage.

[THe clinical aspects of benign prostatic hypertrophy: the times are changing]. / Aspectos clínicos de la hiperplasia benigna de la próstata: los tiempos cambian.

To determine if the incidence of benign prostatic hypertrophy (BPH) had increased in the general population and to reevaluate the therapeutic approaches, we reviewed and compared the clinical records, surgical procedures and therapeutic results achieved in 198 patients that had undergone surgery in 1980 (52 patients) and 1990 (146 patients). We observed that the number of BPH procedures had increased in 1990. These, however, had been performed earlier in the course of the disease, in younger patients with more severe, but better controlled pathologies.