[Artificial urinary sphincter in the treatment of urinary incontinence caused by sphincter insufficiency]. / El esfínter urinario artificial en el tratamiento de la incontinencia urinaria por incompetencia esfinteriana.

OBJECTIVE: To evaluate the results relative to continence and the complications of the artificial urinary sphincter in the treatment of urinary incontinence due to sphincter incompetence. METHODS: The artificial urinary sphincter model AS 800 was implanted in 35 patients with incontinence arising from various causes. Follow-up ranged from 14 to 108 months (mean 39.8). Patients ages ranged from 4 to 68 years (mean 44.4). There were 17 female (49%) and 18 male patients (51%). The cuff was implanted around the bladder neck in 25 patients (71%) and around the bulbous urethra in 10 (29%). RESULTS: There were 2 mechanical device failures, 2 pump erosion and 1 tube erosion through the abdominal wall in a patient who had had a perforation of an augmentation cystoplasty. Thirty-one patients (88%) became continent. Ten patients (28%) had another operation for device revision or relapse. CONCLUSION: The artificial urinary sphincter is a valid alternative in the treatment of urinary incontinence due to sphincteric incompetence. It is possible to achieve good continence rates, although there is a high revision rate and lifetime follow-up is required.

[Synchronous bilateral renal cell carcinoma]. / Carcinoma de células renales bilateral sincrónico.

Until very recently, bilateral renal cell carcinoma was considered to be of very poor prognosis due to the poor results obtained with either radiotherapy or chemotherapy, which were completely ineffective in this type of tumours. In 1952, Krumbach performed the first radical nephrectomy and partial nephrectomy to a patient with bilateral synchronic renal cell carcinoma. This aggressive approach to bilateral renal cell carcinoma definitely changed the prognosis of these patients. Other authors with broad series of patients have clearly demonstrated that aggressive treatment of these tumours is the only approach that can offer patients a life opportunity with a significant 5-year survival ranging between 60-77.8% from the time of surgery.

[Megacalycosis complicated with stenosis of the pyeloureteral junction]. / Megacaliosis con estenosis de la unión pieloureteral sobreañadida.

Contribution of a case report of megacalycosis in a nine and a half-year old male child, in whom the disorder was diagnosed by our team when he was only four. The intense colic pains experienced by the child together with the isotopic renogram non responsive to seguril typical of obstruction, raised the diagnosis of superimposed stenosis of the pyeloureteral attachment. As a result, an Anderson-Hynes pyeloplasty was performed. Post-operative status after four years is absolutely normal from both a clinical and scintiscan point of view.

[Alkaptonuria, prostatic calculi, and ectopic ureter]. / Alcaptonuria, litiasis prostática y uréter ectópico.

Alkaptonuria is an uncommon tyrosine metabolism disorder. Deficit of homogentisic acid oxidase leads to the elimination of large amounts of homogentisic acid in the urine with accumulation of homogentisic acid oxidized pigment in the connective tissue (ochronosis). The ultimate evolution of ochronosis is degenerative arthritis. The clinical case reported is a 57-year old male diagnosed with alkaptonuria in an early stage of the connective tissue disease who comes to the clinic due to a lower urinary obstructive syndrome secondary to benign prostate hyperplasia but is diagnosed with giant prostate lithiasis. The patient undergoes retropubic adenomectomy with lithiasis removal and re-implantation of ectopic ureter from a dual left excretory system. Clinical evolution is completely successful. The rarity of the case calls for circulation and revision of the clinical and therapeutical aspects of this entity.

[Stasis priapism secondary to PGE1: transformation into high-flow priapism]. / Priapismo de éstasis secundario a PGE1: transformación en priapismo de alto flujo.

Since vasoactive agents were first introduced for the diagnosis and treatment of Erectile Dysfunction (ED), the most feared side effect has been priapism. The arrival of Prostaglandin E1 (PGE1) limited to a large extent the incidence of this complication due to its fast systemic and intracavernous metabolism. A case of stasis priapism following a low dose PGE1 injection (10 mcg) after 48 hours evolution and its surprising conversion to high flow priapism after the surgical procedures performed to solve this complication is presented here.

[Cyst of the seminal vesicle. Importance of transrectal echography in this type of malformations]. / Quiste de vesícula seminal. Importancia de la ecografía transrectal en este tipo de malformaciones.

Presentation of one case of seminal vesicle cyst with no associated anomalies. Review of diagnostic procedures useful in this type of disease, illustrating the relevance of transrectal ultrasound scanning due to its high specificity and low morbidity. Comments on the therapeutical options for this entity.

[Nerve endings in cryptorchid testicles]. / Terminaciones nerviosas en testículos criptorquídicos.

The authors have carried out an optic and ultrastructural study of cryptorchidic testicles, confirming classical observations, but calling the attention towards the existence of an increased number of nerve endings in the cryptorchidic testicles in relation to those which have descended, and pointing out the characteristics of these endings and the regressive changes which they undergo.