[Massive vesicoinguinal hernia and acute renal failure. An infrequent association]. / Hernia vesicoinguinal masiva y fracaso renal agudo. Una asociación poco frecuente.

OBJECTIVE: To report a rare complication of acute renal failure secondary to massive vesicoinguinal hernia. To our knowledge, only 4 cases have been previously reported in the literature. METHODS: Herein we describe a case of massive vesicoinguinal hernia in a patient that had presented at the emergency services with symptoms of acute renal failure. The diagnostic and therapeutic aspects of this rare complication are discussed. RESULTS: Patient evaluation showed a left inguinal hernia and benign hyperplasia of the prostate. Blood analytical findings were compatible with acute renal failure. A left massive vesicoinguinal hernia was detected on ultrasound evaluation and confirmed by retrograde cystography. Treatment was by surgical repair of the inguinal hernia, bladder repositioning and cervicoprostatotomy plus TUR of the excrescent bladder lesions to resolve the obstruction. CONCLUSIONS: Massive vesicoinguinal hernia may go undetected if the symptoms are unremarkable and may mimick those of acute renal failure.

[Bacterial content of the enucleated prostate gland]. / Contenido bacteriano de la glándula prostática enucleada.

OBJECTIVE: To determine the prevalence of prostatic colonization or infection in patients undergoing prostatic surgery for obstructive symptoms due to benign hyperplasia of the prostate (BPH), to identify and quantitate the microorganisms isolated in quantitative bacterial tissue cultures, and to determine the influence of open surgery vs endoscopy on the microbiological findings. METHODS: A prospective study was conducted on 175 patients undergoing surgery for BPH. All patients were entered into a study protocol that included quantitative bacterial cultures of prostatic tissue. Data of previously defined variables were entered into a data base for subsequent analysis comprised of redefinition of the variables and descriptive and analytical studies. RESULTS: 44 of the 175 patients (25.1%) had a positive bacterial culture of prostatic tissue. Histological lesions indicating prostatitis associated with BPH were found in 68 of the 175 patients (38.9%), regardless of the presence or absence of bacteria. Of these 68 patients with histologically demonstrated prostatic inflammation, only 19 (27.9%) had a positive prostatic tissue culture. The incidence of granulomatous prostatitis was 1.1%. CONCLUSIONS: The presence of bacteria was demonstrated in prostates of a significant number of patients (25.1%) undergoing prostatectomy for BPH. The microorganisms most frequently isolated in the quantitative bacterial cultures were, by order of frequency, coagulase negative Staphylococci, Escherichia coli and Enterococcus faecalis, which were present in concentrations of at least 10(4) CFU/Gm in prostatic tissue of 79.6% of the cases. No differences were found between the type of procedure the patient underwent and the presence or absence of prostatic infection.

[Inflammatory changes in the obstructed prostate: the correlation between the bacteriological and histological findings]. / Cambios inflamatorios en la glándula prostática obstructiva: correlación entre los hallazgos bacteriológicos e histológicos.

OBJECTIVES: To analyze the incidence and nature of the prostatic inflammatory changes, to determine the prevalence of prostatic colonization or infection in patients undergoing surgery for benign hyperplasia of the prostate (BPH) and to correlate the inflammatory lesions with the bacteriological findings. METHODS: A prospective study was conducted on 175 patients undergoing surgery for BPH. All patients were entered into a study protocol that included quantitative bacterial cultures of the prostatic tissue and histological analyses of the surgical specimens. Data of previously defined variables were entered into a data base for subsequent analysis comprised of a descriptive and an analytical study. RESULTS: 44 of the 175 patients (25.1%) had a positive bacterial culture of prostatic tissue. Histological lesions indicating prostatitis associated with BPH were found in 68 of the 175 patients (38.9%), regardless of the presence or absence of bacteria. Of these 68 patients with a histologically demonstrated inflammation of the prostate, only 19 (27.9%) had positive prostatic tissue cultures. The incidence of granulomatous prostatitis was 1.1%. CONCLUSIONS: Histological lesions indicating prostatitis associated with BPH were found in 68 of the 175 patients (38.9%). The presence of bacteria was demonstrated in the prostates of a significant number of patients (25.1%) who underwent adenomectomy for BPH. No differences were found between the patients with a positive or negative bacterial culture and histological evidence of prostatitis.

[Relationship between preoperative urine cultures and prostatic gland cultures in patients treated for benign prostatic hyperplasia]. / Relación entre los cultivos de orina preoperatorios y los cultivos de la glándula prostática en pacientes intervenidos de HBP.

OBJECTIVES: 1.--Investigate the bacteriuria preoperative in patients who will be operate on for Being Prostatic Hyperplasia (BPH). 2.--Define the prevalence of the prostatic colonization or infection. 3.--Try to correlate the bacteriological findings of urine and prostate, and find the degree of concordance between the microorganisms which can be commonly found in urine and prostatic tissue. METHOD AND MATERIALS: Prospective series of 175 patients undergoing prostatectomy for obstructive symptoms. The protocol revealed, among others variables: the preoperative urine culture; the presence or the absence of catheter; and the quantitative bacteriological culture of prostatic tissue. The information could be analised and its results could be obtained later on. The analysis stages consisted of both a descriptive and an analytic study. RESULTS AND CONCLUSIONS: 1.--Only 36 patients (20.6%) presented bacteriological increase of microorganisms (> or = 10(4) UFC/ml) in the preoperative urine culture. The Escherichia coli was the most common microorganism, followed by the Enterococcus faecalis, coagulase-negative Staphylococcus and the Pseudomona aeruginosa. A single microorganism grew in 31 out of the 36 positive cultures. 2.--The prevalence of the infection or colonization of the prostatic tissue was 25.1% (44 patients). The most common isolated microorganism was the coagulase-negative Staphylococcus followed by the Escherichia coli and the Enterococcus faecalis, in concentrations of at least 10(4) UFC/gr of tissue in the 79.6%. A single microorganism was isolated in 32 out of 44 patients. 3.--The proportion of positive prostatic cultures, in patients with positive urine culture (38.3%), was significantly higher than the one obtained in patients with negative urine cultures (16.5%) (p < 0.0001). Nevertheless, 52.3% of the 44 patients with positive prostatic cultures had negative urine culture, and only 21 (58.3%) out of the 36 patients with positive urine cultures presented a bacteriological growth in prostate. The degree of concordance (Kappa index) between the microorganisms which were found in preoperative urine and prostatic tissue is low or none for the majority of them.

[Liposarcoma of the spermatic cord: a report of a new case and a review of the literature]. / Liposarcoma de cordón espermático: aportación de un nuevo caso y revisión de la literatura.

Malignant paratesticular tumors are uncommon. Of these, liposarcoma of the spermatic cord constitutes a rare tumor. Only a hundred cases have been reported. They are typically presented in elderly people. The usually have a good prognosis because of their low level of malignancy and their relapses tend to be localized. It has a high rate of survival over 5 years. Preoperative diagnosis is infrequent, it is suggested by the appearance of a progressively enlarging mass in the scrotum and the ultrasonography which shows a solid mass of the spermatic cord that is independent of the testicle. The choice treatment is radical orchidectomy, while long-term follow-up of these patients is mandatory because of local relapses. When local relapses become evident, the choice treatment is extensive local excision followed by adjuvant radiotherapy. In the present study we report a new case of a recurring, well differentiated spermatic cord liposarcoma of the type sclerotic, in a 50-year-old man. An exhaustive review of the literature has been made.

[Vesico-uterine fistula: report of 2 new cases]. / Fístula vésico-uterina: aportación de dos nuevos casos.

Contribution of two new cases of vesicouterine fistula secondary to a cesarean incision. In one case, diagnosis was achieved through cystography and cystoscopy, while in the second case cystography, cystoscopy and stain testing (methylene blue) were used. In both cases management was through transperitoneal and transvesical fistulorrhaphy. The two cases showed favourable post-operative evolution with no relapse.

[Vesical bilharziasis. A report of a new case]. / Bilharziosis vesical. Aportación de un nuevo caso.

OBJECTIVE: To describe an additional case of urinary schistosomiasis, a rare disease in our setting. METHODS/RESULTS: The clinical, radiological and cystoscopic features of urinary schistosomiasis are presented. The patient responded well to treatment with praziquantel. CONCLUSIONS: Urinary schistosomiasis, a condition produced by infection with Schistosoma haematobium, is rare in our setting. However, it should be considered in patients with sporadic episodes of hematuria that have immigrated from or travelled to areas where this disease is endemic. A detailed clinical interview can provide this useful information.

[Vesicovaginal fistulae: review of our caseload]. / Fístulas vésico-vaginales: revisión de nuestra casuística.

Presentation of a review of vesico-vaginal fistulae diagnosed and treated in our Hospital between 1978-1992. There has been 20 cases. Etiology is varied, with predominance of cases due to gynaecological surgery. Considerations on diagnostic tests used in each case and the various therapeutical approaches applied, as well as on the results obtained. A revision is made of literature available on this condition.

[Renal trauma in children: our experience and review of the literature]. / Traumatismos renales en la infancia: nuestra experiencia y revisión de la literatura.

Twenty-seven cases of kidney injury in children under 15 years old are reviewed. All of them were diagnosed, treated and subsequently followed in our Service between 1979 and 1992. Clinical evaluation, blood and urine analyses, and imaging techniques are the three basic tools in the management of kidney injuries. Regarding imaging techniques, dynamic CT is currently the best diagnostic method, mainly due to its high anatomic resolution and because it permits evaluation of renal function and of possible associated lesions in other organs. Kidney injuries were classified into three categories: I (18 cases), II (4 cases), and III (4 cases). The last injury affected a pathological kidney. Emergency surgical procedures were performed in 7 cases (25.9%): 2 were category II, 4 category III, and the pathologic kidney that suffered trauma. Surgery was deferred in one case (category II) and the remaining 19 cases (74.1%) were treated conservatively: 18 were category I and 1 category II. Nephrectomy was required only for the pathologic kidney. All the other kidneys were preserved.

[Carcinoma of the penis: our experience in 24 cases and review of the literature]. / Carcinoma de pene: nuestra experiencia en 24 casos y revisión de la literatura.

Squamous cell carcinoma of the penis has a very scant incidence in our setting and evolves slowly. From 1978 to 1991, 24 cases of penile carcinoma had been treated and followed at our service. The results achieved with partial amputation of the penis have been highly satisfactory for stages T1 and T2, which was combined with postoperative radiotherapy for the latter tumor stage. Since carcinoma of the penis generally presents with infection, if lymphadenectomy is performed, it has to be performed after the amputation. The peculiar features of this disease, patient characteristics and the diversity of the therapeutical approaches make penile carcinoma a lesion whose treatment is controversial and, in many cases, difficult to follow.

[Spontaneous rupture of excretory tract caused by calculous impact]. / Rotura espontánea de vía excretora por impacto litiásico.

Herein we describe a case of spontaneous rupture of the fornix with urinary extravasation, an uncommon urological condition arising from a sudden increase of intraluminal pressure due to a calculus in the terminal ureter. The etiopathogenesis, follow-up and therapeutic approach are discussed.

[Stress urinary incontinence. Our results with the Burch's technique]. / Incontinencia urinaria de esfuerzo. Nuestros resultados con la técnica de Burch.

The aim of the surgical procedures utilized in the treatment of stress urinary incontinence (SUI) is to correct the posterior ureterovesical angle defect, thereby improving transmission of intraabdominal pressures to the urethra. We report our experience on 61 patients that had been diagnosed with SUI at our service from June 1984 to December 1990. Treatment was by the same operative procedure (Burch Technique) in all patients. The methods of exploration and the prognostic factors that might influence the outcome of the procedure are described. The short-term (3 months) success rate was 95%, the medium-term (1 year) 85.7% and the long-term (5 years) 77.1%. We underscore the convenience of prophylactic heparin therapy to prevent possible thromboembolic complications.