[Adrenal pseudocyst. Report of a new case and review of the literature]. / Pseudoquiste adrenal. Aportación de un nuevo caso y revisión de la literatura.

Adrenal pseudocyst is the commonest type of benign lesions of adrenal gland althought is a very rare entity. Most of them are found as "incidentalomas" during imaging studies. A case of a patient with a left non-functioning and asymptomatic adrenal pseudocyst is reported. The diagnostic and therapeutic options are discussed and the literature is reviewed.

Pseudoquiste adrenal. Aportación de un nuevo caso y revisión de la literatura / Adrenal pseudocyst. Report of a new case and review of the literature

Los pseudoquistes adrenales son las lesiones quísticas mas frecuentes de la glándula suprarrenal, si bien constituyen una rara entidad. Se detectan cada vez con mas frecuencia en estudios radiológicos como incidentalomas. Se presenta el caso de una paciente con pseudoquiste adrenal izquierdo no funcionante y asintomático. Se realiza revisión de la literatura y se estudian las diferentes actitudes diagnósticas y terapéuticas

Adrenal pseudocyst is the commonest type of benign lesions of adrenal gland althought is a very rare entity. Most of them are found as “incidentalomas” during imaging studies. A case of a patient with a left non-functioning and asymptomatic adrenal pseudocyst is reported . The diagnostic and therapeutic options are discussed and the literature is reviewed

Valoración del daño renal post-litotricia / Postlithotrity renal damage determination

El objetivo del presente trabajo es cuantificar el daño renal producido por la litotricia, identificar a que nivel se produce y establecer el tiempo de recuperación de los daños producidos. Material y método: Se realizó un estudio prospectivo y aleatorio a un grupo de enfermos afectos de litiasis renal y que iban a ser tratados con litotricia. Se establecieron unos parámetros de exclusión e inclusión para los pacientes realizándose a los elegidos unos estudios analíticos previos al tratamiento, repitiendo las mismas determinaciones a las 24 horas, cuarto día y décimo día. Resultados: Se observan elevaciones transitorias en microalbuminuria, excreción urinaria de N-acetil glucosamina y alanino-amino-peptidasa. Conclusiones: Se aprecia que tras una sesión de litotricia se produce daño renal tanto a nivel glomerular como tubular, estableciéndose la recuperación del daño glomerular en cuatro días mientras que la recuperación tubular es mas lenta no regresando a valores normales hasta el décimo día (AU)

[Synchronous primary urologic triple neoplasia. Report of a new case and review of the literature]. / Triple neoplasia urológica primaria sincrónica. Aportación de un nuevo caso y revisión de la literatura.

Herein we present the case of a patient who went to the emergency department complaining of haematuria. With a conservative management, the radiologic and endoscopic studies show a bladder tumour and an incidental left renal mass. After several radical procedures, the last a cystoprostatectomy, it was shown that the patient had a new tumour inside his prostate gland. We comment the surgical procedures, the clinical evolution and the five years follow-up. We review the few cases described in the literature.

Triple neoplasia urológica primaria sincrónica. Aportación de un nuevo caso y revision de la literatura / Triple synchronous urologic neoplasm. Cse report and review of literature

Presentamos el caso clínico de un paciente que acudió al Servicio de Urgencias por presentar hematuria. En tratamiento conservador, los estudios radiológicos y endoscópicos pusieron de manifiesto la existencia de un tumor vesical y una masa renal izquierda incidental. Tras varias intervenciones quirúrgicas, la última, una cistoprostatectomía radical, se constató también la existencia de un nuevo tumor en el interior de la próstata. Se comentan los procedimientos quirúrgicos, la evolución clínica y el seguimiento a cinco años. Se revisan los escasos casos descritos en la literatura (AU)

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[Usefulness of endourologic catheters in the treatment of urinary lithiasis]. / Utilidad de los catéteres endourológicos en el tratamiento de la litiasis urinaria.

OBJECTIVE: To review the indications and complications of the use of endourological catheters in the treatment of urinary lithiasis and choice of catheter based on its physical and hydrodynamic characteristics and biocompatibility. METHODS: Data from our experimental and clinical studies, as well as those published in the literature are summarized. RESULTS: Polyurethane, C-flex and Percuflex catheters have the highest retaining capacity, while the silicone, Urosoft and Wiruthan catheters have the lowest. The tensile strength of polyurethane and copolymers is superior to that of silicone. The friction coefficient, which varies within the same material, influences the facility of catheter insertion. The number and size of the side vents are essential to catheter hydrodynamic behavior. Silicone is the most biocompatible material, followed by Urosoft. The polyurethanes and C-flex catheters cause important urothelial hyperplasia and edema of the lamina propia. CONCLUSIONS: The choice of endourological catheter should be individualized and based on the clinical indication. For prevention of obstruction from steinstrasse post-lithotripsy, a catheter with a high extraluminal flow and high retaining capacity is indicated to facilitate passage of stone fragments and to avoid catheter migration.

[The double-J ureteral catheter: its historical development and current status]. / El catéter ureteral doble-J: desarrollo histórico y situación actual.

OBJECTIVE: To review the history of the development of the double-J ureteral catheter, a device that is necessary in current urological practice. METHODS/RESULTS: A review of the literature shows that although there are references on the use of the ureteral catheter before 1967, the history of its development began in that year, when Zimskind and co-workers designed and used the first self-retaining catheter that was inserted cystoscopically. However, it was not until 1978 when the double-J shape was adopted following the design of Finney. CONCLUSIONS: A review of the history of bioimplants development in the field of Urology shows that catheter design and its biomaterials have developed in parallel, in an attempt to create a device that functions well and one that is also well-tolerated by the body in order to reduce the catheter-related complications.

[Wunderlich syndrome caused by the rupture of a simple cyst in a patient treated with acetyl salicylic acid]. / Síndrome de Wunderlich por rotura de quiste simple en paciente tratada con ácido acetil salicílico.

Report case of a Wunderlich syndrome due to spontaneous rupture of a simple renal cyst. The patient is a 77-year old, hypertensive female who was on routine treatment with Aspirin. The rarity of retroperitoneal haemorrhage with this origin is documented; also the influence of aspirin as predisposing factor for this condition is ruled out. Brief evaluation of the various diagnostic means available. An accurate evaluation that may allow to adopt a conservative aptitude is recommended.

[Double J ureteral catheter. Clinical complications]. / El catéter ureteral doble J. Complicaciones clínicas.

OBJECTIVE: To analyze the clinical complications of double-J ureteral catheters. METHODS: The most relevant studies published in the literature since the self-retaining indwelling catheter was first described in 1967 are reviewed. RESULTS: The experience and results reported in the most relevant studies are presented. CONCLUSIONS: The double-J ureteral stent has become an integral part of the urological armamentarium. It allows good urinary drainage from the kidney to the bladder and is generally safe and well-tolerated. However, different complications may occur with short- or long-term use of indwelling stents. These complications vary from minor side effects such as hematuria, dysuria, frequency, flank and suprapubic pain, to major complications such as vesico-ureteric reflux, stent migration, encrustation, urinary infection, stent fracture, necrosis and ureteral fistula. Most of these complications require removal of the catheter.

[In vitro study of the process of urinary calculi fragmentation with endoscopy, light microscopy, and scanning electron microscopy]. / Estudio in vitro del proceso de fragmentación de los cálculos urinarios con endoscopia, microscopio óptico y microscopio electrónico de barrido.

Stones with different compositions respond differently to shock wave lithofragmentation. Likewise, the various lithotrity systems used may have different effects on the stones. To determine the relationships between stone composition and their fragmentation patterns, we conducted an in vitro study using endoscopy, magnifying glass, light microscope and scanning electron microscope on fragments obtained after lithotrity of 60 pure stone with different compositions: calcium oxalate monohydrate and dihydrate (OXMH and OXDH), phosphocarbonate (PC), ammonium magnesium phosphate (AMF) and uric acid (UA). Fragmentation was carried out with 4 different lithofragmenting sources (electrohydraulic, piezoelectric, ultrasound and pulse laser). No morphologic differences in the fractures induced by the various lithofragmenting sources were demonstrated. OXMH and UA stones basically break up by intercrystalline fracture and splitting of their concentric plates. OXDH breaks up mainly by intercrystalline fractures aided by the fibrillar organic material and phosphocarbonates found in the intercrystalline spaces. Fragmentation in infective stones (AMF and PC) occurs across the intercrystalline surfaces and by intracrystalline fracture. Ammonium urate fragments break up by intracrystalline fractures that run across the equatorial plane of its characteristic acicular microspheres.

[The proximal migration of a double-J catheter. A review of the predisposing factors. Apropos a case]. / Migración proximal del catéter doble-J. Revisión de factores predisponentes. A propósito de un caso.

Case report of a patient bearer of a double-J ureteral catheter due to ureteral lithiasis. After persistent renoureteral pain and fever, the proximal migration of the catheter is confirmed radiologically. The predisposing factors for this complication, described in the literature, are reviewed.

[Radiopacity of double-J ureteral catheters. Computed tomography quantification and clinical implications]. / Radiopacidad de los catéteres ureterales Doble-J. Cuantificación por T.A.C. e implicaciones clínicas.

OBJECTIVE: To determine whether knowledge about the degree of radiopacity of the double-J ureteral catheters utilized in Spanish hospitals suffices for correct radiologic control and subsequent follow-up. METHODS: The CT attenuation index was utilized to determine the degree of radiopacity of 23 double-J ureteral stents, comprised of different biomaterials and from different manufacturers, that are used in Spanish hospitals. RESULTS: The values ranged from 1,000-3,070 Hounsfield units. CONCLUSION: All the catheters analyzed were sufficiently radiopaque to permit good radiologic control during insertion and subsequent follow-up. The radiopacity of the stent depends on the metal salt employed during the manufacturing process and not on the biomaterial.

[In vitro study of urinary calculi fragmentation with 4 different systems of lithofragmentation]. / Estudio in vitro de la fragmentación de los cálculos urinarios con cuatro sistemas de litofragmentación diferentes.

The results of shockwave lithofragmentation are conditioned by stone composition. Similarly, the different types of lithofragmenting energy can have different effects on the calculi. The purpose of this experimental study is to establish a relationship between calculi composition and type of energy used for fragmentation, with the results of the lithotriptsy treatment. 60 calculi, 12 for each pure composition selected (calcium oxalate mono and dihydrate, phosphocarbonate, ammonium magnesium phosphate and uric acid) underwent in vitro lithofragmentation with 4 different lithofragmenting sources (electrohydraulic, piezoelectric, ultrasound and pulsed laser). It was carried out a study of fragmentation in particles under 3 mm and pulverization in particles under 0.5 mm, analyzing post-lithotriptsy fragments with scanning electron microscopy associated to X-ray dispersion energy. No relationship was shown between calculi composition and amount of energy supplied for the fragmentation. The lithiasic composition correlates to the fragmentation pattern, so that oxalocalcium calculi undergoes good fragmentation and poor pulverization, infective calculi have poor fragmentation but good pulverization and uric acid calculi show poor fragmentation and pulverization.

[In vitro study with techniques of imaging of the composition of urinary calculi]. / Estudio in vitro mediante técnicas de imagen de la composición de los cálculos urinarios.

Pre-treatment knowledge of the lithiasic composition can be useful to design the most appropriate therapeutic scheme for each kind of stone. The relationship between the stone's densitometry information provided by the different imaging techniques, conventional radiology (RX), computerized axial tomography (CAT) and dual energy radiographic densitometry (DO) is analyzed, as well as the elemental composition determined by the microanalysis of fragments obtained post-lithotrity using a scanning electronic microscope (SEM) associated to X-ray dispersion energy (XDE). 60 stones, 12 for each pure composition selected (calcium oxalate mono and dihydro, phosphocarbonate, magnesium ammonium phosphate and uric acid), were studied with XR, CAT and DO and were later subjected to lithofragmentation in vitro. Fragments analysis was carried out post-lithotrity with SEM associated to XDE. The X-ray does not allow to establish the composition of some calculi. CAT quantifies the mineral contents of the oxalocalcic and infective calculi and differentiates the uric acid from the other compositions because the mean density values are under 500 Hounsfield Units. DO evaluates the lithiasic content in phosphocarbonate salts which are structurally similar to bone hydroxyapatite.

[The double-J ureteral catheter. Clinical indications]. / El catéter ureteral Doble-J. Indicaciones clínicas.

OBJECTIVE: To analyze the clinical indications of double-J ureteral catheters. METHODS: The most relevant studies published in the literature since the self-retained indwelling catheter was first described in 1967 are reviewed. RESULTS: The experience and results reported in the most relevant studies are presented. CONCLUSIONS: The double J ureteral catheter is essential in urological practice. Although its clinical indications are well-established, its use depends on the urologist's experience in most of the cases.

[Changes in physical characteristics of endourologic catheters caused by shock waves]. / Modificaciones de las características físicas de los catéteres endourológicos inducidas por la onda de choque.

OBJECTIVE: To analyze the shock wave effects on double-J stent. METHODS: Retention strength modifications induced by shock waves were analyzed: a) 60 double-J stents obtained from patients were compared (20 had not been treated by ESWL; 20 had been treated by piezoelectric-ESWL and 20 by electrohydraulic-ESWL; b) the effects of piezoelectric-ESWL were determined in vitro using 36 stress-tested double-J stent segments (Urosoft, C-Flex and silicone) vs. a control group. RESULTS: The retention strength of the stents from ESWL-treated patients, especially those that had been submitted to piezoelectric-ESWL, was lower than in stents from patients that had not undergone ESWL (p < 0.05). The foregoing has been corroborated by the in vitro findings. The impact frequency causing maximum damage is specific for each material. Microphotographic studies revealed fracture lines on the surfaces of the ESWL-treated stents (Urosoft and C-Flex). CONCLUSIONS: The foregoing findings may explain the high incidence of double-J stent migration observed in ESWL-treated patients.

[Hydrodynamic behavior of endourologic catheters]. / Comportamiento hidrodinámico de los catéteres endourológicos.

OBJECTIVE: The present study analyzed the hydrodynamic behaviour of the double-J stent. METHODS: Thirty-two double-J stents of different sizes and biomaterials (16 new and 16 removed from patients) were hydrodynamically evaluated using two models: a) nephroureterocystectomy surgical blocks harvested from pigs and b) an in vitro experimental model of the upper urinary tract. The following parameters were measured: initial and final weights, encrusted material weight, inside and outside diameters, number, size and distribution of sideholes, wall thickness, drainage area and length of time the catheter was indwelling in the patient. RESULTS: Double-J stent placement in a normal upper urinary tract constitutes a partial obstruction that is proportional to the caliber of the catheter. Ureteral-flow reduction is 83%, 61% and 58% for 5FR, 6FR, and 7FR catheters, respectively. Extraluminal obstruction of the catheter reduces ureteral flow more than intraluminal obstruction (74%, 43% and 25% for extraluminal versus 83%, 66%, 57% for intraluminal for 5FR, 6FR and 7FR, respectively). Vesicoureteral and vesicorenal reflux pressures were 6.2 +/- 0.3 cm H2O and 35.2 +/- 2 cm H2O, respectively. CONCLUSION: Selection of a double-J stent must be individualized on the basis of indication, time indwelling, sex and route of insertion.

[Endoscopic cervicotomy: elective treatment in bladder neck sclerosis]. / Cervicotomía endoscópica: tratamiento de elección en la esclerosis del cuello vesical.

OBJECTIVES: The present study compared the efficacy of perimetric resection of the sclerotic ring (TR) and two-incision endoscopic cervicotomy (TC) for bladder neck sclerosis. METHODS: Fourteen cases (11 primary and 3 recurrence) underwent perimetric TR using a conventional 24 F curved loop resectoscope to excise the sclerotic diaphragm completely. In 11 cases (9 primary and 2 recurrence following previous perimetric (TR) two deep incisions were made at 5 and 7 o'clock with the Collins blade. Occasionally, the Sachse urethrotome had to precede the insertion of the conventional 24 F sheath. RESULTS: Of the 14 cases with bladder neck sclerosis that underwent perimetric TR, 5 (36%) recurred, while no recurrence was observed in the 11 patients treated by double TC. The results were assessed on the basis of the clinical findings and control flowmetry. CONCLUSIONS: Dysuria was the most common clinical symptom and was confirmed by flowmetry. Confirmation must be done endoscopically and preferably under anesthesia to permit treatment, if required, during the same session. TC is more reliable and TR is not advocated because of the high recurrence rate.

[Treatment of urethral stenosis with endoscopic urethrotomy with local anesthesia]. / Tratamiento de la estenosis de uretra mediante uretrotomía endoscópica con anestesia local.

We evaluated the efficacy of local anesthesia for endoscopic urethrotomy in 20 cases of urethral stricture. Patient clinical features and maximum urine flow data before and after the procedure were compared. The technical difficulties encountered are described. Bladder neck sclerosis and/or stricture of the posterior urethra complicated the procedure. Endoscopic urethrotomy using local anesthesia is effective in the treatment of urethral stricture.

[Treatment of recurrent bladder surface tumors with laser Nd:Yag: a single-year experience]. / Tratamiento de los tumores vesicales superficiales recidivantes con laser Nd:Yag: un año de experiencia.

Management of surface vesical tumours using laser photocoagulation has proven to be a safe and effective method. The technique can be performed under anaesthetic sedation and in the outpatient clinic environment thus allowing a considerable cost saving and the reduction of hospital's waiting lists. Throughout 1990, 47 patients with relapsing vesical tumours were treated in 55 sessions. Most cases were performed on ambulatory patients with a low complications rate and an estimated saving of 18,326,400 pesetas as compared to transurethral resection.