[High-flow priapism: early diagnosis and treatment]. / Priapismo de alto flujo: diagnóstico y tratamiento precoz.

Contribution of a new case of high-flow priapism as clinical expression of an arterial-cavernous fistula caused by perineal injury. The diagnostic sequence was blood gasometry by means of puncture-aspiration of the cavernous body to establish the 'high-flow' taxonomical diagnose, with negative response to the intracavernous injection of vasoactive drugs; it was followed by arteriography, showing that the clinical picture was the result of an arterial-cavernous fistula, allowing at the same time a superselective therapeutic embolization. Vascular permeability and erection recovery were confirmed by ECO-doppler at the two- month assessment.

[Renal angiomyolipoma. Our case histories]. / Angiomiolipoma renal. Nuestra casuística.

We reviewed the cases of angiomyolipoma that had been diagnosed and treated in our urology services from 1978 to 1991. The study showed a higher incidence in the females; it frequently presented as a solitary tumor; a high specificity was found for the US (hyperechoic mass) and CT (areas of low attenuation ratio) findings. Owing to these diagnostic techniques, conventional surgery is no longer the only treatment. Embolization is considered to be the first therapeutic approach.

[Ureteral obstruction secondary to endometriosis. Report of a case]. / Obstrucción ureteral secundaria a endometriosis. A propósito de un caso.

The urinary tract is rarely affected by endometriosis, urinary bladder being the most common location. This paper presents one case of advanced extrinsic endometriosis which initially presented as obstructive pyelonephritis. The diagnostic methodology, including uro-tomographic imaging, is evaluated. Although good results have been reported with hormone-therapy, we support the surgical approach sanctioned by the patho-anatomical findings.

[Ambulatory treatment without anesthesia of urinary lithiasis by extracorporeal shock-wave lithotripsy: 7,000 cases]. / Tratamiento ambulatorio sin anestesia de la litiasis urinaria mediante litotricia extracórporea por ondas de choque: 7.000 casos.

Exposition of results and complications in 7,162 consecutive sessions with Shockwave Extracorporeal Lithotripsy (SWEL) applied to 3,950 lithiasis located at all levels of the urinary tract. These procedures have been performed without sedation or anaesthesia. Diuresis was not forced during or after treatment with serotherapy, mannitol, or diuretics. Treatment was conducted in an outpatients clinic in all cases. The treatment/lithiasis ratio in this initial series was 1.7. Following therapy, 7.09% of patients treated attended the emergency unit due to colic pain/fever. 3.60% of patients treated required hospitalization due to major complications: subcapsular-retroperitoneal haematoma, 9 cases; ureteral obstruction, 120 cases; septicemia, 22 cases; renal function annulment, 11 cases and death, 2 cases.

[Urinary sepsis as manifestation of a renal angiomyolipoma]. / Sepsis urinaria como manifestación de un angiomiolipoma renal.

Renal angiolipomas are the most frequent benign renal tumours. Since ultrasound techniques have been in use to study algetic lumbar syndromes, their symptomatic appearance has decreased. Most authors agree that CAT has a 100% specificity. The paper contributes one case of renal angiomyolipoma isolated in a 39-year old woman, its primary interest being the clinical presentation, within an extensive septic milieu of urinary origin, the intra-operative diagnosis, considering the previous false-negative echography and dubious tomographic diagnoses, and the findings of regional node invasion, all exceptional states in the reviewed literature.

[Leukoplakia of the upper urinary tract]. / Leucoplaquia del tracto urinario superior.

Leukoplakia is a morphological term that attempts to define keratinizing desquamative squamous metaplasia of the transitional epithelium. It is uncommon in the upper urinary tract (less than 100 cases have been reported) and has been attributed to infection or mechanical injury to the epithelium and/or genetic factors. We present a case of leukoplakia in a male patient with renal tuberculosis that had been in remission for the past 15 years. Eight years earlier he had intermittently passed keratin laminas (pathognomonic of leukoplakia) during the course of various episodes of nephritic colic. After discarding a reactivation of tuberculosis and malignancy of the metaplastic lesion, we continued conservative treatment with radiologic and cytologic control evaluations.

[Therapeutic embolization of a renal angiomyolipoma associated with tuberous sclerosis]. / Embolisation thérapeutique d'un angiomyolipome rénal associé à une sclérose tubéreuse.

The authors report about one case of bilateral renal angiomyolipoma, which is interesting because it is associated with tuberous sclerosis and was revealed by chronic anemia, and because of the treatment chosen, which consisted in the selective embolization of the neovessels. Follow-up at one year showed the reduction of the tumoral mass and the proper function of the remaining renal parenchyma.

[Treatment of ureterocele in the adult]. / Tratamiento del ureterocele en el adulto.

Review of 18 cases of ureterocele in the adult. The first clinical symptoms are unspecific, with a long-term evolution, and were found while carrying out routine urological examinations. The association to secondary lithiasis in over 60% cases and the presence of complete duplicity in 44% cases is highlighted. The choice treatment is by endoscopy in the simple cases without hydronephrosis or associated reflux. The technique of transversal incision in 'smiling mouth' at the base of the ureterocele produces good results.

[Kidney preservation]. / Preservación renal.

Extensive literature review on the current state of organs preservation; solutions and methodology. Major advances in immunosuppression methods and the ongoing increase in the number of renal transplants encourage the search and investigation of better preservation techniques. Continuous pulsatile perfusion and perfusion plus hypothermal storage represent the two most frequently used techniques nowadays. In spite of the advantages shown by the former in the case of prolonged cold ischemia, hypothermal storage remains as a practical technique widely used in our environment.

[Renal mass as the initial manifestation of a metastasized oat-cell]. / Masa renal como primera manifestación de un oat-cell metastatizado.

Renal metastasis of localized tumours in the economy are rare. In our series of 162 renal tumours only 3 were metastatic. Even more unusual is that the metastasis should be the presenting form. Such is the case we are reporting: a 59 year-old male complaining from back pain and toxic syndrome. Supplementary examinations were performed sequentially until arriving at an open biopsy which confirmed the oat cell histology. The paper explains the results from the various examinations. The ominous prognosis of this histology is illustrated.

[Urinary diversions: our experience and selection approach]. / Derivaciones urinarias: nuestra experiencia y actitud de selección.

Retrospective review of 126 urinary by-passes performed in our service over the last 15 years where efficacy and complications arisen from the ureteroileal by-passes, ureterosigmoidostomy and skin ureterostomy are analyzed. Patients were found to be pre-operatively homogeneous with no statistically significant differences with regard to age, renal function or previous radiotherapy, except in the case of ureterostomies which are always initiated from a poorer renal function and general condition. It was concluded that there was no difference between the various Bricker types according to the anastomosis, which allows joint a comparison with other groups. After three months, Bricker's showed better radiologic evolution than Goodwin's (p less than 0.08) and a statistically lower number of complication (p less than 0.05) therefore establishing they should be the choice procedure versus any other type of by-pass. Literature review with regard to results and conditions of container reservoirs and vesical substitutions, evaluating their contraindications within the neoplastic scope and/or psychosocial range, as well as comparing the reflux, stenosis and infection rates with our series, make the ureteroileal by-pass a technique entirely legitimate at present.

[Germinal tumors of the testis. A caseload and review of the literature]. / Tumores germinales de testículo. Casuística y revisión bibliográfica.

Between 1974 and 1988, 35 testicle germinal tumours, 16 seminomas and 19 non seminomas, were studied. Mean age in seminoma cases was 34 years and 26 in non seminoma cases; the former were mainly presented as located stages at the time of diagnosis (75%) while the latter were, on the contrary, mostly stages II and III. Following orchiectomy, all histologically pure seminomas received radiotherapy with the exception of two cases. All of them are presently free from the disease with an average follow-up of 2.8 years (range 0.5-5 Yr.) Radiotherapy continues to be proposed as first choice therapeutic action for siminomas in located stages, although we do not disagree with other more conservative possibilities. In the non seminoma group, all three patients diagnosed in stage I were clinically controlled without supplementary therapy, two of them having a recurrence during the first year of follow-up, but currently free of the disease after chemotherapy and surgery of residual masses. Of the three non seminoma patients in stage II, with negative post-orchiectomy markers, two underwent lymphadenectomy and the other one only chemotherapy. In the remaining group of non seminoma patients, and always after an orchiectomy, chemotherapy was performed as first choice therapy, although rescue lymphadenectomy was required in eight cases. Chemotherapy schemes with cisplatin have relegated to a second level any other therapy for the non seminoma patients. The excellent response and reduction of side effects allow the adoption of more conservative attitudes. This paper explains our retrospective study and, following a wide review of exiting literature, discussed any conflictive prognostic and therapeutic items.

[Rigid ureteroscopy: results and complications]. / Ureteroscopia rígida: resultados y complicaciones.

We make an evaluation of 66 ureteroscopies (URS) carried out in our Service over a period of 18 months. In 55 cases it was done for therapeutic purposes in ureteral lithiasis, and in 11 cases it was for diagnostic purposes. In the treatment of lithiasis resolutive effectivity at the first attempt was 68%, in 9% ureterolithotomy had to be performed due to the impossibility of approaching the calculus, and in 23% supplementary treatment was carried out by means of external litrotripsy. In the diagnostic field, effectivity was 72%. Notable complications arose in 6 cases (9%), 6 ureteral perforations, in three of which a urinoma was formed, all settled with a double J catheter. Open surgery was not resorted to in any case. No sequelae were observed and this technique therefore showed itself to be safe and effective.

[Adrenal masses discovered incidentally]. / Masas suprarrenales de aparición incidental.

The introduction of new diagnosis techniques has made the study of the suprarenal gland much more accessible. In particular, ultrasonography, CAT and MRI have contributed to the increased detection of suprarenal masses by chance, and this raises problems when it comes to deciding the attitude to take to the diagnosis of these masses. We present nine suprarenal tumours, most of which appeared in the course of follow-up of patients suffering from carcinoma of the bladder. On detecting a suprarenal mass, we carry out a morphological study with CAT as well as determination of hormonal activity and puncture with cytology of the mass, according to the schema proposed by Copeland. We comment on the most significant clinical aspects and on the criteria of action proposed by various authors.