[Transdermal iontophoresis with dexamethasone and verapamil for Peyronie's disease]. / Iontoforesis transdérmica con dexametasona y verapamilo para la enfermedad de la Peyronie.

OBJECTIVES: To evaluate the effects of transdermal iontophoresis with verapamil and dexamethasone in patients with Peyronie's disease of less than one year of evolution. MATERIAL AND METHODS: We have treated ten patients twice a week during six consecutive weeks using iontophoresis with a Miniphysionizer dispositive. This device generates a 2mA electric current during 20 min which triggers the transdermal penetration of medication. In every session dexamethasone 8 mg and verapamil 5mg were administered inside a small self-adhesive receptacle on the penile skin overlying the fibrosis plaque. To evaluate the efficacy, penile curvature was measured by Kelami's test, while the plaque size was assessed by penile ultrasound. Other parameters like pain, erectile function and ability for vaginal intercourse were recorded using questionnaires. Safety parameters were also assessed during treatment. RESULTS: No improvement or progression in penile curvature was evidenced in any of the patients. The hardness of the plaque was reduced in 5 patients, becoming impalpable in 2 of them. Decrease in plaque volume was observed by penile ultrasound in 6. Pain improved in 8 patients, disappearing in 6 of them. One patient recovered his erectile function at the end of the treatment; whereas 3 referred that their ability for intercourse enhanced while 2 reported that treatment improved their sexual life in general. We didn't record any significantly side effects, except for a transitory and slight dermal redness on the site of electrode placement. CONCLUSIONS: Transdermal iontophoresis is an effective treatment for pain control in early stages of Peyronie's disease. Efficacy in reducing penile curvature seems to be limited. Controlled clinical trials are needed, and perhaps reviewing indications in order to obtain more relevant clinical effects.

[Laparoscopic lymphadenectomy in the treatment of stage I non-seminomatous germ cell tumors]. / Linfadenectomía laparoscópica en el tratamiento de los tumores germinales no seminomatosos estadio I.

OBJECTIVE: To review the role of laparoscopic lymphadenectomy for stage I nonseminomatous germ cell tumor of the testis. METHODS: The current literature on this subject is reviewed and the advantages and disadvantages of this technique are discussed. RESULTS/CONCLUSIONS: Although there is no agreement on the management of nonseminomatous germ cell tumors of the testis, some groups advocate performing retroperitoneal lymphadenectomy after orchidectomy, particularly for tumors with a high risk of dissemination. The laparoscopic approaches that were introduced basically in the 90's, have permitted performing surgical techniques with a low morbidity and a shorter recovery time. Laparoscopic retroperitoneal lymphadenopathy is one such technique. According to the experience of several groups, this technique has an acceptable operating time (approximately 5 hours), low complication rate and short hospital stay (2-5 days according to the different series). For those with experience in performing the laparoscopic approach, it is a therapeutic alternative that should be considered for this type of testicular tumor.

[Complications of radical nephrectomy in the treatment of kidney adenocarcinoma]. / Complicaciones de la nefrectomía radical en el tratamiento del adenocarcinoma de riñón.

PURPOSE: To evaluate the peri- and post-surgical complications in Renal Adenocarcinoma (RAC) treated with Radical Nephrectomy (RN). MATERIAL AND METHOD: Revision of 109 patients with RAC who underwent transperitoneal anterior abdominal RN. Patients were locally staged post-surgically as: T1 + T2 61.5%, T3a 22.9%, T3ab 11% and T3b 4.6%. Approach and conservation of homolateral suprarenal gland were decided based on the preferences of the performing urologist. Hilar lymphadenectomy was performed in all cases. RN was done by a staff member in 77% cases and by a training resident assisted by a staff member in the remaining 23%. RESULTS: Peri-operative complications occurred in 10% patients, most commonly with left RN (13% vs. 7%) (p = 0.1), and further within this group the most frequent ones occurred in those using midpoint laparotomy (17.8% vs. 4%) (p = 0.1). Blood transfusion during surgery was required in 23% patients, this being more frequent when tumours had extended into the venous system (47%) and in left RN by midpoint laparotomy (39% vs. 12.5%) (p = 0.02). There were 32 post-surgical complications in 27 (24.8%) patients, the most common being sepsis of the surgical wound (6.4%); complications were more usual in patients undergoing right RN (31% vs. 20%) (p = 0.08) and in patients with blood transfusions (40% vs. 20%) (p = 0.4). There were no deaths. CONCLUSIONS: In our series, RN showed low intraoperative morbidity (10%), non-insignificant post-operative morbidity (24.8%) and no mortality. We consider subcostal laparotomy to be the best surgical approach in left RAC, with low morbidity and low peri-operative blood requirements.

[Endourologic treatment of ureteral ruptures in closed abdominal trauma]. / Tratamiento endourológico de las roturas ureterales en traumatismos abdominales cerrados.

The traumatic fracture of the ureter is a very uncommon entity, which accounts for 1-5% of all urological traumatism. In most cases it is secondary to penetrating lesions, endoscopic or open surgery iatrogeny, its occurrence as secondary to closed traumatism being very rare. The paper presents four patients with partial ureteral fractures caused by closed traumatism. Management was in all cases conservative with endourological methods, using backward ureteral intubation, and no case required the use of other types of complementary surgical approaches; functional recovery of urinary tract was complete in all four patients.

[Lymphocele after renal transplantation: therapeutic controversies in the age of laparoscopy]. / Linfocele postrasplante renal: controversias terapéuticas en la era de la laparoscopia.

We present 11 lymphoceles in 180 consecutive kidney transplants (6%). We study the potential etiologic factors, symptoms, diagnostic evaluation and treatment, stressing the role of laparoscopy in management of bulky and loculated symptomatic lymphoceles. This technique allows to reduce morbidity, increasing efficacy and shortening hospitalization.

[The use of kidney grafts++ from donors of the same age or below 3 years (weight equal or below 15 Kg)]. / Utilización de injertos renales de donantes de edad igual o inferior a 3 años (peso inferior o igual a 15 kgrs).

Over the last few years an impasse has been seen in the number of donors for organ transplantation. This has prompted a re-statement on the use of a group of grafts which, historically, were considered suboptimal: those from donors aged 3 years or under (weight less than or equal to 15 kg). 124 transplantations from corpse donors performed in adults over a 36 months period (Jun 90/July 93) were revised. 24 grafts (19.3%) from donors aged 3 years or under were used. Thirteen (54%) of these grafts were from donors aged 24 months or under, and six (27%) from donors aged 12 months or under. A comparative analysis is made on the clinical and functional evolution of these grafts, as well as their current survival status versus those from donors aged between 3 and 60 years (n = 86, 69.3%). Transplants made with grafts from donors older than 60 years (n = 14, 11.2%) were excluded from the analysis. Our results suggest that use of kidneys from donors aged 3 years or under--weight less than or equal to 15 kg--, implanted as units is acceptable when compared to grafts from older donors. Considering the current impasse in donations for organ transplantation we believe use of this type of donors, as a useful source of grafts, should be advocated.

[Reliability of CAT in the local staging of tumors of the upper urothelium]. / Fiabilidad de la TAC en el estadiaje local de los tumores del urotelio superior.

Presentation of a retrospective study where the reliability of computerized axial tomography (CAT) used in preoperative local diagnostic definition of 20 upper urothelium tumours (UUT) radically treated between 1985 and 1991 is analyzed. Of them, only 70% were located by CAT and, of these, only 56% (45% of total) obtained a clear correlation with their local infiltration stage. Thus, it is concluded that CAT alone is not a good method for the preoperative evaluation of UUTs, at least when it comes to indicate their likely conservative treatment.

[Initial treatment of pyonephrosis using percutaneous nephrostomy. Value of the technique]. / Tratamiento inicial de la pionefrosis mediante nefrostomía percutánea. Valor de la técnica.

Until early in the eighties, the initial treatment of choice for pyonephrosis was by emergency surgical excision, which carried a high intraoperative and early postoperative morbidity and mortality. The introduction of percutaneous nephrostomy, a technique with a low complication rate that permits easy access in dilated excretory tracts and is highly effective, as shown by the clinical and analytical course of the patients with pyonephrotic kidney and by the number of nephrectomies performed, represented a substantial change in the initial therapeutic approach. The present article reports our experience of 123 percutaneous nephrostomies performed in 118 pyonephrotic kidneys over a period of 10 years, which constitutes one of the largest series reported in the literature. The clinical features and the findings disclosed by imaging techniques that permit making the diagnosis are presented. We describe the PCN procedure and its advantages, with special reference to the reduced morbidity and mortality, particularly in those cases complicated by septic shock. The procedure also permits evaluation of the underlying obstructive uropathy and function of the compromised kidney, therefore more renal units can be preserved, nephrectomy can be avoided and morbidity is minimal. For all the foregoing reasons, PCN guided by an imaging technique is currently the most effective initial treatment of pyonephrosis.

[Transcatheter arterial embolization in the hemorrhagic complications of kidney trauma]. / Embolización arterial transcatéter en las complicaciones hemorrágicas del trauma renal.

Transcatheter arterial embolization is a nonsurgical alternative for the complications arising from biopsy, surgery and blunt or penetrating renal trauma. Fourteen transcatheter embolization procedures were performed in 13 patients for hemorrhage following biopsy of the native kidney (3 cases) biopsy of the transplanted kidney graft (3 cases), stone surgery (3 cases), blunt abdominal trauma (2 cases), a stab wound (1 case) and an A-V fistula (1 case). The bleeding was effectively controlled in all cases. Nephrectomy was required in 3 cases (21.4%) whose kidneys were not viable and cannot be ascribed to a complication of the embolization procedure. The diagnostic aspects of hemorrhage arising from renal trauma, the embolization technique and its indications are discussed. In our view, transcatheter arterial embolization is the technique of choice for the hemorrhagic complications of blunt or penetrating renal trauma or those caused by biopsy or surgery.

[Urethral sonography in the diagnosis and preoperative evaluation of urethral stenosis]. / Sonouretrografía en el diagnóstico y evaluación preoperatoria de la estenosis de uretra.

An area of spongiofibrosis can be found proximal and distal to all stenosis of the urethra. The severity of such spongiofibrosis as well as its length are in many instances decisive when choosing an adequate surgical approach. Conventional radiological diagnosis of stenosis of the urethra only shows the area of urethral stricture but is unable to inform on the fibrosis of the spongy body. Sonourethrography or urethral echography affords a dynamic tridimensional examination of the anterior urethra which provides accurate data on the length of the stenosis, as well as the extend and severity of the spongiofribosis. Sixteen patients diagnosed with stenosis of the urethra through sonourethrography were evaluated. This easy-to-perform investigation, allowed the identification of 4 patients with peristenotic intense spongiofibrosis, hypercongenital urethra, who underwent open urethroplastia. The urethra of another 3 patients showed normal echogenicity, but diminished elasticity, and were diagnosed as of moderate spongiofibrosis requiring extensive internal urethrotomy. We believe sonourethrography should become a procedure to be included as part of the routine pre-surgical investigation of the stenosis of the urethra due to its non-invasive nature, easiness to perform, and because it provides highly useful information which would allow a decreased number of re-stenosis following surgery of the urethral stenosis.

[Current treatment of ureteral lithiasis. Review of our experience]. / Tratamiento actual de la litiasis ureteral. Revisión de nuestra experencia.

Retrospective analysis from June '89 to January '91 of 198 patients seen in our Hospital for ureteral lithiasis using 'in situ' ESWL as the first therapeutic choice. The number of sessions per calculus was 1.45, 68.7% cases receiving only one session. 84.2% calculi were resolved by ESWL, with associated instrumental manoeuvres in less than 15% cases. Our hospital's therapeutic algorithm for the 15.8% calculi where ESWL failed is presented. The conclusion is that 'in situ' shock wave extracorporeal lithotripsy represents a perfectly valid alternative for the treatment of ureteral lithiasis regardless its location.